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Ensuring a peaceful farewell

The Straits Times (9 April 2015) - For several months, Mr T’s family noticed he was becoming increasingly gaunt, and that his abdomen looked bloated. 

The elderly man, who was suffering from chronic diseases, such as diabetes, high blood pressure and high blood cholesterol, refused to see a doctor.

He was finally admitted to the hospital after suffering a fall.

While warded, he developed breathing difficulties and his condition declined swiftly. An X-ray scan confirmed that he had a chest infection.

Soon, he was in the intensive care unit (ICU) and placed on a respirator. Another scan revealed a large mass in the lung, as well as spots in his liver and abdominal cavity.

He was diagnosed with advanced lung cancer which had spread. Within two days, Mr T had to depend fully on the machine to breathe. His condition was “terminal”.

The traditional goals of the ICU are to prolong life and decrease the chances of death and any adverse outcomes. Despite technological and medical advances, some patients will not have any prospect of meaningful recovery and death will be inevitable.

I was part of the palliative care team that received a call from the ICU team to help Mr T and work with his family on a palliative care plan.

When we sat down with the family and talked, we found out that Mr T was a very pious man.

As a health-care attendant working in a hospital operating theatre, he had witnessed unsuccessful attempts at resuscitation and did not wish to undergo the same treatment.

His family said he believed that living and dying are part of the circle of life.

To him, a good death would be one where he is surrounded by loved ones and in his own home instead of the hospital.

CARING FOR THE DYING

Mr T was dying.

He was put on medication to ease his pain. At the same time, support was given to family members as they were faced with the reality of having to say goodbye soon.

On top of the sea of emotions they were grappling with, the family had to make the difficult decision of whether to keep Mr T on the respirator or respect his final wishes.

After several discussions with the palliative care team, they decided there was nothing more important than to honour Mr T’s wish to spend his final days at home.

With the assurance that the hospital and the home hospice team will support them, plans to bring Mr T home swung into action. The day came and he was taken home on a portable ventilator and a portable device to administer medication for breathlessness and pain. The home hospice team took over the care at home and his breathing tube was removed.

He passed away peacefully the following day, surrounded by his loved ones, in the comfort and familiarity of his own home. His family were able to carry out the ritual cleansing and prayers for him, in accordance with his religious beliefs.

DIGNITY IN DEATH

Death can be dignified, and in a manner consistent with the values and wishes that the patient holds dear to.

According to the World Health Organisation, palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering.

This can be done by means of early identification, as well as the timely and accurate assessment and treatment of pain and other problems, be they physical, psychosocial and/or spiritual.

Outside of the ICU, palliative care helps to reduce patients’ pain and symptoms so as to provide the highest quality of life. Inside the ICU, palliative and critical care go hand in hand to help patients – and their families – in their final days.

Doctors, nurses and therapists work together to provide medical care to the patient. Social workers provide much-needed counsel to families to help them make decisions based on what is important and meaningful to the patient.

While death may be inevitable, the process need not be painful, lonely or traumatic. When patients die, the manner in which they do so will live on in the memories of their loved ones.

A peaceful death often provides some comfort for those who live on.

In the words of a family member of another patient who had received palliative care in the ICU: “It was a difficult decision to have the tube removed, but thank you for making the process more humane and for giving us the chance to have closure.”

 

Dr Poi Choo Hwee is a consultant in general medicine at the Palliative Care Clinic at Tan Tock Seng Hospital, which is the flagship of the National Healthcare Group (NHG), the Regional Health System for Central Singapore.


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Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.