This article was adapted from one of Natalie's end-of-posting assignments from the NUS Yong Loo Lin School of Medicine.
I cannot help but envy my classmates whose reflections tell stories which are not their own. As they embarked on their palliative care posting, my family embarked on a ferry to lay my grandfather's remains to rest at sea.
I sometimes wonder if there was any point at all in studying medicine. After all, doctors are but mere mortals – what can we do but acquiesce when God calls our patients home? And if modern medicine is unable to reverse death, then what role do doctors play in the denouement of their patients' lives?
When my grandfather went for a check-up at Tan Tock Seng Hospital, his abnormal liver function test results prompted the medical team to order an MRI of his liver, revealing extensive metastases originating from the pancreas. My grandfather had Stage 4 pancreatic cancer – with just weeks to live.
While the diagnosis was a huge blow to us all, it also enabled us to make the necessary preparations. The palliative care team organised family conferences with us and worked closely with the hospice team to fulfil my grandfather's final wishes – to die peacefully and painlessly at home, surrounded by his loved ones.
And so, after intensive coordination and logistical preparations, a terminal discharge was arranged for my grandfather. We all agreed on the plan in the event that his symptoms worsened (eg, calling 995 and subjecting him to CPR was an absolute no-go) and we learned how to administer fentanyl to manage his pain.
An hour before he passed away, my grandfather surfaced briefly from his fog of hyperbilirubinaemia. I happened to be the first person he saw when he opened his eyes; just as well, for I have always been his greatest pride and joy. As our eyes met, he smiled widely, and I was overwhelmed by a flood of emotion.
His tachypnoeic breathing eventually transitioned to slow, gasping breaths, the interval between each breath lengthening until the next breath never came. As I felt his pulse fade beneath my fingers and his hands grew cold in mine, I reflected on what a privilege it was to be able to share this final moment with him in the intimacy of our own home.
Even in the midst of my sorrow and bitterness, even as I resented the limitations of modern medicine – still so ineffectual in the face of death after decades of innovation – I was thankful for this precious moment.
This precious moment of intimacy and humanity made possible by a team of dedicated doctors who cared enough to find out what mattered most to their dying patient and his family.
It has often been said that the journey matters more than the destination. Death remains the final, inevitable destination for all of us, but medicine has the power to alter the journey, the memories we make along the way and ultimately, our life's narrative. The doctor's responsibility, therefore, extends far beyond merely prolonging life; first and foremost, it is to empower his/her patients, even within the constraints of their failing health, to live life to the fullest and achieve their aims.
And this art of medicine, I believe, is something worth dedicating a lifetime of study to master.
To my grandfather:
Thank you for sharing your love for reading and writing with me. After three years of your nagging, I finally decided to send my work to SMA News for the first time.
This article is dedicated to you: to celebrate your life, to honour your memory, and to offer consolation to those learning to live with loss.