A group of seven ward nurses are standing around Mr Tan's* bed – three on each side and one at the head. They have just helped Mr Tan put on a smart-looking long-sleeved shirt and Mr Tan is feeling breathless. He needs to rest for a few minutes before the nurses can transfer him from his ward bed to a trolley bed. His daughter is standing along the corridor just outside the room, dressed in white and putting on lipstick. She is getting ready for her tea ceremony which is about to take place in the ward's day room. I come in to check on how Mr Tan is doing; he looks very apprehensive about being transferred to the trolley bed. I stand beside him and say: "Don't worry Mr Tan, I am here. Let's do this. If you are breathless, I will give you some extra medicine." We then transfer him to the trolley bed, comb his hair, put on his tie and wheel him to the day room where he is served tea by his daughter and the groom.
Mr Tan was referred to the palliative medicine division on Thursday, just one day before the tea ceremony, because his advanced cancer was rapidly progressing. It was making him breathless with minimal exertion – even talking made him breathless. He had one last wish: to attend his daughter's wedding and give a father's blessing to the newlyweds. So, we started him on some opioids to control the breathlessness and made logistical arrangements so that he could participate in the tea ceremony on Friday morning and attend the wedding dinner on Saturday night. With the help of everyone in the team, he managed to attend the wedding dinner and came back to the hospital all smiles, happy that he was able to fulfil his last wish. He passed away just over a day later, in the early hours of Monday morning. That was it – he was referred in on Thursday and died four days later on Monday. At least we managed to fit in a tea ceremony and a wedding dinner during those brief four days that we were caring for him.
Energy to carry on
Days like these remind me of why I studied medicine and became a doctor: to make a difference in people's lives. Days like these keep me going and give me joy. Yet how do I find joy in my work, which is widely perceived as utterly depressing? Each of my patients has a serious illness – most commonly advanced cancer, sometimes end-stage heart failure or respiratory disease. Each of my patients has a limited prognosis – usually months at most, sometimes weeks, sometimes only days. All of my patients are dying.
Yet the truth is that all of us are dying. Some of us are just more aware than others. Some of us are forced to face the inevitability of our mortality, while others get to live in denial of it. As a palliative medicine doctor, my patients constantly remind me of my own mortality. It may seem counter-intuitive, but knowing that my life is only transient makes me treasure it even more. It motivates me to focus on what really matters. It reminds me to make the most of every day and savour each moment. It reminds me to live each day well, because after our days are spent comes certain death.
"Teach us to number our days, that we may gain a heart of wisdom." (Psalm 90:12)
With my limited and transient life, why did I choose to work with the dying? The dying are, in fact, still living and palliative care is about helping patients to live well until they die. It is at this time that they are often most vulnerable, suffering from pain and other physical discomforts while being forced to contemplate the value of the lives they have lived as they face the reality of approaching death. Being able to journey with patients at life's end, and to ease their suffering along the way, is a great privilege. This is why I chose to be a palliative medicine doctor. The opportunity to connect with another person and make a difference is what keeps me going. It makes it all worthwhile.
*Mr Tan is not his real name and details have been altered to protect his identity.