Palliative care dept at TTSH (ST Nov 28, 2008)

It is first public hospital to do so; move follows growing need to improve lives of the terminally ill By Salma Khalik

WHEN her father and grandfather died two weeks apart after losing their battles with cancer, Ms Angeline Chew was devastated.

Fortunately, she was able to draw strength and comfort from palliative care doctors and nurses at Tan Tock Seng Hospital (TTSH). They helped the family members come to terms with their imminent loss, while also seeing the patients through their painful last days.

The need for such support has grown over the years. Once offered exclusively to terminally ill cancer patients, palliative care has since been extended to other terminal illnesses such as organ failure. Last year, palliative care doctors at TTSH helped more than 1,400 dying patients and their families, up from 1,100 in 2005.

To cope with the larger numbers, the hospital has decided to set up a department devoted solely to palliative care - the first public hospital to do so. If it works out well, a Ministry of Health spokesman said others would follow suit.

With the change, the current team of four doctors will be able to grow the service with more nurses and registrars, as well as train more doctors in this field, said Dr Wu Huei Yaw, a consultant in palliative medicine at TTSH.

Only about 60 per cent of people who need palliative care are getting it, Health Minister Khaw Boon Wan said recently.

Palliative care doctors treat not only physical symptoms such as pain and breathlessness, but also the emotional and spiritual needs of the patient. They spend a longer time with each patient, with a new case taking anything from 30 to 60 minutes for the first consultation.

The question they most often have to deal with is 'Why me?', said Dr Wu. Patients, especially those in their 30s or 40s, often protest that they are not ready to die.

Older patients, on the other hand, are usually less afraid of death, but they do fear pain and suffering, he added. This can be helped by palliative care doctors explaining what they can do to alleviate suffering.

If the pain gets really bad, they will get anaesthetists to administer an injection into the spinal cord - like epidurals given to women in labour to help them cope with the pain. In extreme cases, a patient can be kept sedated till he dies.

Ms Chew's father suffered from intense pain in his last days. But 'his eyes would light up when Dr Wu or the nurses came by', she recalled.

He knew they were doing their best for him, and was grateful. Dr Wu once returned to the hospital at 10pm when he heard that Mr Chew was in great pain.

Mr Chew was given a 'terminal discharge' after the doctors told his family that there was not much more healing they could give him. Instead, he would die at home, while his pain treatment continued through a home hospice care service.

Dr Wu said an increasing number of patients and their families are opting for terminal discharge.

Last year, more than 50 patients chose to go home. This year, more than 80 have already done so.

Another new department, called Community and Continuing Care, is working with nearby nursing homes to provide their patients with palliative care, so there is no need for them to be admitted.

This is better for both the patient - who does not have to be shuttled to and fro - and the hospital, which faces a perennial shortage of beds.

When first approached some months before her father's death, Ms Chew, who is in her 30s, was upset and rejected their help. Her father was only 57 years old, and the diagnosis of late-stage colon cancer came as a shock.

'I thought the doctors had given up on my father and were sentencing him to death,' the mother of two young children said. 'I couldn't have been more wrong.'

(source: www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_307844.html )

My comments:
I recalled the recent demise of my mother-in-law. She was discharged from SGH around June 2008 and hospice care was given because she was deemed to be terminally ill. Since then, a nurse and occasionally a doctor from Hospice Care Association would visit her weekly, talking to her, ensuring her health condition was still "fine".

Lately, when my mother-in-law was unable to move around, a wheel-chair and a toilet pan were loan. Morphine solution was given to relieve pain and suffering. Just a few days before she passed on, the nurse said that my mother-in-law might be at the last stage of her life and advised her family members to spend more time with her. True enough, my mother-in-law left this world within a week.

Special thanks goes to Debbie, who is so patient, thoughtful and sensitive to our needs.