Steven was diagnosed with Nasopharyngeal Carcinoma (NPC-Cancer of the Nose Ear and Throat) Stage IV in September 2006. The cancer cells had spread to the brain and at the base of skull, despite the fact elsewhere in the body was cleared of tumor.
He was given multiple treatments rounds of Radiotherapy and Chemotherapy in 2006 to 2010.
He had struggled to seek treatment everywhere (for proton treatment, even to Loma Linda and Harvard) but was rejected by most centres. He then turned to all alternative and complementary medicine, including Traditional Chinese Medicine, Ayurvedic, Gerson Diet, Chi Gong and spiritual healing. Anyone who suggested any new treatments will be taken up by Steven and his family of 10 brothers and sister. They pooled their resources to help finance expensive and painful treatment which did not seem to have any effects and the least… a cure.
Meanwhile Steven health and general conditions deteriorated. When he was finally referred by me to see the palliative care consultant in June 2010, he was extremely reluctant to receive palliative care, as he wanted to fight on and did not believe that he cannot be cured. He also refused to take morphine to relieve his pain as he believed that it will make his condition even worst.
He thought that morphine was poisonous, addictive and dangerous. He also knew that by starting on morphine, it was an end for him. He is a fighter and wants to continue to "fight till the end" (in his own words). Death seems like an unspeakable word and I can only use all my knowledge on counseling to make sure he makes the right decision.
The Oncologists were definitely supportive of his fight for survival. At this time, they continued to recommend chemotherapy and radiotherapy as if it was like murder (due to the side effects) and profiteering. Palliative radiotherapy or chemotherapy was the oncologists' offer for such terminally illed patients. When will they ever give up and hand the patient to a palliative care physician to managed quality of life issues and pain management? I must say I am not impressed by some of the doctors Steven had consulted in the private hospital, who insisted that 3 more dose of radiotherapy should be given even at the last stages of his life at S$10,000 each.
Steven's condition deteriorated in 2011. He could hardly hear from his left ear (due to the treatment) and his right ear was deaf by Jan 2011. He was completely blind (both eyes) in early Mar 2011. In May 2011, he could not swallow and have to be tube-fed through the nose. It was extremely uncomfortable for Steven. Soon, he could no longer walk. In June 2011, he could not longer hear nor speak nor walk, nor swallow, and remained in his room most of the time.
Steven was alert, in his own world, with no sound, no sight and no speech. He would response if you shouted near his ear, touch his hand and call out his name. I continued to see him weekly, whenever possible, except when I have a flu, or when I was too tired to see him in this condition. He recognised that it was me when he touch my hand and felt my mala.
His family's support also went down with his condition, perhaps with compassion fatigue, or caregiver fatigue. Care for Steven was entrusted to the Burmese maid, who placed a TV in Steven's room and watches the TV by the bedside while keep a lookout on him. On many visits, the children were watching TV in the living room as I walked up the stair alone to sit next to Steven. I gave instructions on tube-feeding and physiotherapy to exercise the muscle to the maid and the children. Everyone seemed to be so exhausted from the daily bed care.
As a counselor, the most difficult part for me was the final phone call from the family informing that the patient was dying. I received an SMS sent by his wife from Steven's handphone at 4.41pm on 27 Aug 2011. I was driving at the time and once I could get off the steering wheel, I called Steven's wife. She asked for my opinion as they were considering whether they should call the ambulance and send Steven to the hospital. He had fever and his breathing was rather slow. His urine was also very little and was brown in colour. I was aware that similar situations of high fever had occurred in May and in June 2011, and the family sent Steven via ambulance to Changi General Hospital. He then stayed in the ICU for a few days and then discharged back to home in one or two weeks.
I spoke to the family, who this time thought that it would be a futile effort to send Steven to the hospital. His eldest son had agreed since they had all the required medicined at home and they would be administering the same medicine at the hospital. Since they asked me for my opinion, I told them that Steven would prefer to die at home in the company of his loved one and families. If they called for the ambulance, he could die in the ambulance or the hospital. I suggested to let him feel comfortable and informed all his families members to come and say their final goodbyes. I told them that they could call me again if they need further assistance and I would come the next morning to see Steven.
Steven passed peacefully at 11.45pm on that night 27 Aug 2011.
May you be well, happy, peaceful.
With Gratitude,
ROBIN
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You're a good friend, Robin. May he rest in peace.
ReplyDeleteThanks for sharing.