Nov 10, 2010

The Final Piece of the Puzzle

I went to Taipei last week to attend a conference on hospice and palliative care. For those unfamiliar with medical care, palliative care is defined by Wikipedia as "any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure." It may sound radical at first sight, but if you take a macroscopic look at our current medical system, you're bound to be disappointed by limited treatment regimens, unknown disease etiology, and aimless aggressive treatment, especially in cancer.
When we've done pondering what we can't do in medicine, we start thinking about what we can do for these terminal patients. To quote a 15th century anonymous statement on medical care - to cure sometimes, to relieve often, to comfort always - this is our work. This is the first and great commandment. And the second is like unto it - Thou shalt treat thy patient as thou wouldst thyself be treated. When we really go grassroot to ask terminal patients what means the most to them, we knew by heart most would want to spend it at home surrounded by family and friends. Yet current medical care do not permit this. We see death as a medical failure, and doctors try their very best to prevent death from happening. As majority of medical students say when entering med. school "I am going to save lives."

The truth is, death is an all but natural process. We may delay it with current medical technology but we can never avert it. Death is part of the four living cycles in Buddhism, and just like giving birth or getting married, it only happens once.
During the conference we were lectured about the history of hospice and palliative care in Asia Pacific, apparently Singapore, Taiwan, and Malaysia are quite forward when it comes to facing death. We were exposed to how and why it is very important to discuss the issue of imminent death with our patients even if their still alive and talking - techniques such as "will you be surprised if this would be the last year of your life?" is a good way in assessing if patients are ready or open-minded to discuss this morbid issue. Approach death in a honorable way, respect our patients' wishes, and fulfill it when the time arrives.
It is shocking that although 80% of patients wish to pass at home, only 30% get to do so. Our lecturer from Birmingham described to us how an average English man dies - even when he has agreed to DNR (do not resuscitate order), when he falls or faints the care home operator or a family member will immediately summon an ambulance and rocket straight to the hospital. Most of the time patients die on the way or in ER, so called "trolley deaths". If vital ideas and communication had occured beforehand the patient might die a more digified and peaceful death.

We also learned about hope. What does hope mean to you? For healthy living adults it may be something impossible to achieve. For a terminally ill patient it may be as simple as getting engaged or baptised, make peace with all enemies. Needless to say it is utmostly important to communicate these and attempt them for the patient. This is the essence of palliative care.
I may not be in the appropriate age to think about death yet, but I believe as we're at an age where our grandparents, parents or even some of our older friends are leaving, we must face this fact - would you like to be treated the way the deceased was treated? Would you be lying on a hospital bed hooked with dozens of tubes and moaning in pain, or would you pass comfortably in your room, your wallpaper, and the people who cherished your company or you come to appreciate during the final days of your life?
Providing hospice and palliative care to all is the future goal all governments must attempt. Medical care comprises of perinatal care, gynecologic and obstetrics care, pediatrics care, chronic diseases, psychological, and even gerontology. It's only natural end-of-life care becomes part of it.