SKCH Senior Pharmacist Lim Chee Yuen shares and reflects on her experience with a palliative patient. She was attached to Faith ward at BVH for the IHPCS (Inpatient Hospice Palliative Care Service) training from 25 July to 8 August 2018.
*This is a real case but names and certain details have been changed to protect the identity of the deceased and his family.
When we first met
Mr K was a 78-year-old terminally ill patient who was struggling with pain from his metastatic cancer. He had no trained caregivers at home and the plan was to have him cared for in the wards till his demise.
I still remember the day I first met Mr K. It was along the corridor of Faith ward at BVH, where I was attached to for two weeks. Throwing pillows around and rambling away, he was displaying signs of hyperactive delirium as he was wheeled to the isolation room.
For the next few days, I shadowed a dedicated team of doctors and nurses on daily ward rounds in Faith ward to learn the ropes. I also got the chance to sit through family conferences and multidisciplinary meetings (MDM), and to participate in physical examination of patients.
Coincidentally, our daily ward rounds often ended with visiting Mr K. Thanks to the excellent care by staff at BVH, Mr K grew more stable and appeared in better spirits as the days passed by. He had few complaints and the team continued making sure that he was as comfortable as possible.
“Is my husband dying?”
“Chee Yuen,” a doctor called out to me one afternoon. “Can you please take a look at Mr K?”
I rushed into Mr K’s room, recalling that he looked fine this morning and could even sit up in bed. Withdrawing the curtains, I saw two nurses administering fentanyl, a very strong pain medication. Mr K looked frail and tired, his eyes were rolled up and he was gasping hard for air.
I tried to comfort him while praying fervently that the medication will start to take effect. It was then that I noticed Mr K’s wife, an equally frail-looking woman in her 70s, by the bedside.
“I was now alone with a frightened old lady and a dying man. For all my years as a healthcare professional, this situation was new to me.”
Holding on to Mrs K’s hands, the doctor updated her gently on Mr K’s condition in Hokkien before she received an urgent call and had to leave. I was now alone with a frightened old lady and a dying man. For all my years as a healthcare professional, this situation was new to me.
Not well-versed in Hokkien, all I remembered saying was “Jiak ba buay (Have you eaten)?” Mrs K said she wasn’t hungry, then asked me earnestly, “Is my husband dying?”
I have never received any official training in palliative care nor have I gone for courses on how to break bad news. Taken aback, I rattled off in a mix of Hokkien, Mandarin and Cantonese: “What is your biggest joy in life, Ah Ma?” She looked away as she wiped her tears off. “To have married K,” she whispered.
Mrs K related how she felt in love at first sight with Mr K. She proudly described how tall, dark and well-built Mr K was in his younger days. “He was a carpenter. We got married when I was 20, and we have two sons.” She paused and continued in tears: “But my two sons had a huge misunderstanding over the carpentry business. They have not spoken to each other for years.”
“Would you like to say anything to Ah Gong?” I asked. “Can he hear me?” she asked me back with her eyes wide open. “Yes, he can,” I said and explained that the last senses to go at the end of life are usually the sense of hearing, followed by touch. I reached out to place her hand on Mr K’s chest. She looked at him for a good minute and spoke words that I couldn’t comprehend. Then she looked at me and said: “My husband is dying. You must get my two sons here.”
The medical social worker (MSW) who then came into the room quickly assured her that Mr K’s family had been informed and they were on their way to the hospital. The exception was Mr K’s younger son who couldn’t be reached despite multiple attempts from the doctor and MSW.
Mr K’s younger son was usually present by his father’s bedside when we did our rounds. He was then facing some personal issues which crippled his ability to care for his father at home but his filial piety was unquestionable.
I felt saddened. Mr K’s greatest wish as a father was probably to have his two sons reconciled. What if he was hanging on for that reason? It was a hectic afternoon with two other patients also on the DIL (dangerously ill list). Snatching pockets of time between seeing different patients, I would try to call the younger son. It got more and more disappointing with each unanswered call.
After a couple of hours and countless calls, Mr K’s younger son finally picked up the phone. He managed to arrive at the hospital in time. Later that night, Mr K passed away peacefully with his family by his bedside. And at his deathbed, his two sons had finally reconciled.
“Mr K has taught me that when we are confronted with death, no amount of technical knowledge can reverse the inevitable
This short stint at BVH has made me think deeper about the value of life.
Death may be a sad event as it brings separation of the living and the dead. But it can also bring together those living for the one who passed on.
Before, I was an arrogant and self-righteous ICU interventionist.
I took pride in my knowledge of medication. However, Mr K has taught me that when we are confronted with death – the biggest enemy – no amount of technical knowledge can reverse the inevitable.
With humility, I saw love and was at peace with myself. I hope that my story can help to ignite your passion to serve and spread the love.
This article was reproduced from SingHealth Community Hospital’s eNewsletter.