Essence of Palliative Care PART 1

Dr. Ling (4th from left) next to Mr. Hung (Kuching Life Care), Dr. Tiong (National Cancer Society) and Lily (far right) at a recent visit to the district of Asa jaya.

EVERYONE KNOWS IT TAKES A VILLAGE to raise a child but how many of us realize it takes that same village to care for one’s aging or dying loved ones? I didn’t but I do now because I have the privilege to see it happening at work everyday. Until we started Hospice Home care and began visiting patients with advanced cancer, near or in the terminal phase of their illness in their homes earlier in 2016, I had not fully grasped the real challenges and complexity involved in the care of a sick and dying loved one in our local community in this day and age. I have been a doctor and an oncologist long enough to know that it is not easy of course, but this was mostly brain knowledge that had yet made the necessary journey to the heart. How could I? I was already too swamped treating patients and saving lives (so I thought) at the hospital!

Mrs T sat quietly across me in my small clinic room, not saying much and avoiding eye contact for the whole half hour or so while I chatted with her husband – my patient with advanced incurable gastric cancer for the last 2 years. Mr T was only in his mid-50s – a strong, independent, athletic man until cancer struck seemingly out of the blue. He had responded well to chemotherapy initially but his cancer had grown resistant to all his treatments at this point and in view of his weakening condition and deteriorating function, we had made the decision to stop active cancer treatment a month or so before. It was obvious to us both that we were now nearing the end of the road. I had been his oncologist but as there was no palliative care physician in the whole of Sarawak, I was now by default his palliative care physician, hoping only that I was good enough.

How’s your appetite? Is your pain under control? He was amazingly positive and answered in the affirmative for all my questions. Promise me you will come any time and let me know if there is anything bothering you? He gave me a smile, nodded and was soon out of my door. I was rather pleased with how the consultation had gone and was just about to call in the next patient on my long clinic list when I looked up and realized Mrs T had not left the room. Rather, she had pulled her seat right next to mine after making sure that her husband had left. With tears in her eyes, she said: “Dr Winnie, I am so, so tired”

I was not unaware of the tremendous needs of course. Having worked previously in countries like Australia and Singapore where Palliative care and Hospice care are advanced and well established, I often caught myself wondering, in my idle moments, how my patients with advanced cancer and their families cope with their increasing needs and dependency that ravaging cancer and deteriorating health bring, given the lack of awareness and limited support in our community. The year previously, my sister Lily – a counselor doing an attachment under her mentor Sr Geraldine Tan (fdcc) at St. Joseph’s Homes and Hospice Singapore – had

called me, inspired by the hospice work she was witnessing there, and asked “Is there a hospice in Kuching?” When I told her not yet, despite the great need for one, she replied: “Let’s build one then.”

Mrs T’s feeble yet urgent cries for help in my clinics that morning rang relentlessly in my ears and tried as I may, I could no longer shut it out. It was the final push I needed to venture out of the comfort and safety of my little clinic into the big scary world of hospice home care in Kuching, Sarawak. Hence the birth of our NGO Two Tree Lodge Hospice Kuching on 1 October 2014. It is here, amidst the undeniable pain and suffering of patients and families dealing with terminal illness and the complexity of it all, that we discover incredible resilience and courage; humanity that gives Hope and above all, the indescribable love that conquers all.

PART 2 to be continued in the next KINO issue #24

Dr Winnie Ling- a proud Sarawakian, is a part time visiting consultant Medical Oncologist at Normah Specialist Medical Centre. She’s also the vice president and medical director of Two Tree lodge Hospice Kuching – an NGO founded on 1st October 2014 with the aim to help develop and expand much needed palliative care & hospice care services in Kuching & Sarawak.

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