Caring for the dying

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Written: Oct 2012

For a Science Journalism module.

Also published in SALT online here.

Caring for the dying

Saving lives may be the priority of many doctors. But to Dr Ramaswarmy Akhileswaran, ensuring that patients live their lives to the fullest before they die is even more important.

Dr Akhileswaran (centre) in a consultation with a patient (left) and a nurse (right) at HCA Hospice. PHOTO: COURTESY OF HCA HOSPICE

The Chief Executive Officer and Medical Director of HCA Hospice, Dr Akhileswaran, or more affectionately known as Dr Akhilesh to his staff and patients, has been practising medical care for the dying – palliative medicine – for 10 years.

Previously specialising in the treatment of cancer patients as a radiation oncologist after being trained in India more than two decades ago, Dr Akhilesh, 53, has been asked the same question many times.

“Other doctors ask me, why choose cancer when 40 per cent of your patients are not going to survive?” he says. “And now, for palliative medicine, it’s even worse – 100 per cent of my patients are dying.”

But Dr Akhilesh finds his passion in caring for patients who are at the last stages of their lives. It is a different challenge compared to treating patients for other illnesses, he admits.  “What’s crucial is not prolonging the patients’ lives, but enabling them to have a better quality of life – reducing their pain, enabling them to go in peace,” he says.

“Sometimes, patients just want us to listen to them. To us, it may not seem much, but to them, it may be a huge difference,” he adds.

He says for healthcare workers specialising in palliative care, showing love, care and compassion towards patients is of utmost importance. “Death is a sensitive topic – no one likes to be told that they are dying,” he says. “It is usually difficult for patients and their family members to accept this fact.”

One common difficulty the palliative medicine specialist often encounters is balancing patients’ expectations and family members’ demands, for instance when the family members request to hide the severity of the patient’s illness from the patient.

“The family members feel that their loved ones would not be able to handle it if they knew they were dying,” he says. “But on the other hand, some patients want to know the truth of their condition. Sometimes they have issues they want to settle before they die, or problems they hope to reconcile with their loved ones, and if they know their days are numbered, they will want settle it so that they will not leave with regrets.”

When confronted with this dilemma, Dr Akhilesh would speak to the family members to understand why they prefer to hide the truth from the patients, and work with them on how they can break the news to the patient stepwise in a gentler manner.

On a more personal level, working with hospice patients is also emotionally draining for Dr Akhilesh. “72 per cent of our patients pass away within three months,” he says. “When we see them, develop a relationship with them and watch them pass on, it affects us. And it happens all over again for the next patient.”

“So very often, we need to recharge, to protect ourselves, to give us the energy and motivation to continue doing what we do,” he added. He spoke about a particular instance when his personal friend for several years was diagnosed with rectal cancer. This friend was a middle-aged volunteer at HCA Hospice and used to play the piano for patients. He chose to receive home hospice care to be in the company of his elderly mother.

“I never expected that he would become a patient himself,” says Dr Akhilesh. But he never managed to see him before he passed away in 2006. “I knew he wanted to see me that day – he was just admitted into Dover Park Hospice. I rushed down, but it was too late,” he says. “I reflected a lot on what happened. Ultimately, I had to tell myself – I did my best. We just have to move on from there.”

To many patients, Dr Akhilesh is a doctor who genuinely cares for them.

Low Soo Eng, 67, who has been a day care patient at HCA Hospice for four years after being diagnosed with kidney failure, says in Hokkien: “I can’t speak English to the doctor, and he also doesn’t speak Mandarin or dialect, so I can’t say a lot to him. But he always tries to see that I’m well, whether I’m in pain or uncomfortable. He’s a doctor who really loves us.”

Dr Akhilesh sees giving the best care he can as his duty. He says: “Treating the dying requires greater sensitivity and resilience. We need to be patient with them, respect their wishes, and we need to be emotionally strong to go through the last stages of their lives with them. It’s not easy.”

To ensure that his team understands how to deal with complicated cases, such as problems with patients and their family members, Dr Akhilesh holds a meeting with his HCA nurses twice a week to discuss each case that the nurses need help with.

Senior nurse manager Angela Tan, who has been working at HCA hospice for two years, says: “He will make sure that the nurses know what to do, and also assess our medical knowledge from time to time. We learn a lot from him.”

Dr Akhilesh’s work has also inspired some medical students to specialise in palliative medicine. He gives lectures to local medical undergraduates twice to thrice a year. Some were even inspired to volunteer as medical social workers at the hospice.

He also shares his experiences with his wife, a local pathologist, and occasionally with his two sons aged 19 and 23.

To him, being a specialist in palliative medicine is more than simply the job itself. “Learning about palliative care allows us to reflect on life and death, and many things that are out of our control,” he says. “We learn to deal with many emotions, make a difference, and it makes us better human beings.”

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