A very good day to all of you.. I suppose this is one of my entries that would probably go under a different heading compared to my other previous ones.. I know, usually I would write about the present happenings or the unforgettable past, but this is a little bit different.. I would be honoured should you take a small piece of your time to take a small peek on what I would very much like to share.. It may not seem significant to our life at the moment, but I can assure you, a lot of reflections can be made and, maybe, some of us could see a bit of room for this..
What Is This Palliative Medicine?
Palliative Medicine is probably one of the youngest of specialties in medicine family.. As a matter of fact, it has only been recognised as a medical specialty by WHO in the recent years, not more than 30 years.. But the history of palliative care tracks back to the early fourth century.. In the beginning, these hospices are places for travellers to rest.. It was not until sometime in the 19th century that a religious order established hospices for the dying mainly in Ireland and London.. It is possible that at that time, Palliative Care was born..
The term Palliative itself comes from a Latin word 'Palliare', meaning 'to cloak'.. Unfortunately, many of us have some reservations with the specialty and services provided by palliative care team.. It is not uncommon to hear people associating the word Palliative Care or Hospice with Cancer or even Death.. Even in Ireland itself, where palliative care possibly first began, the locals still see hospices as a place where 'you can check-in but can never check-out'! As a matter of fact, even among general medical physicians, palliative care is still vague and more of a concept than an actual practice.. It is all about how much we know, how much we understand what palliative care entails and what can they offer.. It would be of no harm for me to share a small bit from my experience working in the area..
WHO defines Palliative Care as :
An approach that improve the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosicial and spiritual
It is imperative to understand the few basic concepts in palliative medicine.. As from the definition, the main aim is to improve quality of life.. It does sound straight-forward enough but in fact, the aim of improving the quality of life is more of a practicality and support rather than just throwing suggestions.. Many of these patients suffer from terminal disease (mainly cancer) which is or has become unresponsive to treatment.. An easy example would be widespread disease.. Some may have had chemotherapy treatment but disease still progress, or some other may already have widespread disease at time of diagnosis.. Either way, no further (radical) chemotherapy or radiotherapy can be used to 'cure' the disease.. This is when the call to concentrate on the quality of life becomes a must..
Prevention and relief of suffering is another aspect in the definition that may well need a little explanation to clarify.. It is again important to note that the word 'cure' is not being used.. Alas, palliative care is not about curing.. A large proportion of patients under palliative care suffer from intractable pain, or nausea and vomiting.. And these symptoms, more often than not, are clinical presentations of the progression of the underlying disease.. Believe me, they are not pleasant at the least.. By focusing on prevention and relieving these symptoms, the palliative care team hence are focusing on the quality of life.. Many of these patients require morphine to alleviate their pain.. Of note, morphine is the strongest natural analgesia (pain medication) known to man today.. By relieving pain, these patients can potentially spend more quality time with their family members and loved ones.. This is just an example of many..
These all sounded very scientific.. Do not be alarmed.. Palliative care is still medicine, and medicine is science.. The science of medicine is still very much the basis of management.. Palliative care doctors still prescribe medications to the patients.. In fact, I would say, among the physicians, palliative care doctors are among the best to deal with symptoms like pain, comparable to anaesthesiologists! They prescribe large doses of morphine, yet the attention to detail on the calculation of requirement of each patient is meticulously forwarded..
The Art Bit Is Crucial Too
Special to palliative care is the art of it, as do other specialties have for themselves.. The hard part in understanding palliative medicine lies in the question : When do you stop all measure? This is very difficult to understand until we take a while and sit down to evaluate the theme.. When a person is dying, when does the doctor say "no more IV fluid drips" or "stop all other medications"? This next sentence may sound incredibly disturbing, but I will try to explain at my best effort.. Active treatment is stopped when the probability of having a significant response that can improve quality of life is low.. I emphasize the sentence in bold as one read may sound like "washing their own hands".. I give an example of a frail gentleman with widespread lung cancer and currently having a chest infection.. The decision to NOT treat with antibiotics would be made if the general condition of the man himself would not improve despite having antibiotic treatment.. However, if the man was otherwise mobile and relatively well before the infection, then antibiotic treatment may well be tried to give him a chance of fighting the infection.. This is a hard one to call - as a matter of fact, this would be very common in palliative care setting.. The judgment call to treat or not to treat is the art in palliative medicine..
There are many other examples that would call the doctors up to make a decision as hard as - or even harder than - this.. Dealing with family members is another example.. How do you tell that you feel the patient is dying? What would you say when family members ask about the length of time their relative has? Suffice to just throw samples, just for us to ponder.. Many can debate siding on 'to treat' as many as on the 'not to treat' side.. It is still evidence-based, but taking into account the experience of the doctor and the setting of the situation.. The decision-making call is the art as much as it is science..
Palliative Care And Me : Reflection And Ambition
Alhamdulillah, I have been given the short spell of experience working in palliative medicine in Limerick.. At almost six months, I am fairly happy to prescribe morphine intelligently.. I have the opportunity to work with two very experienced consultants in Milford Care Centre.. Dr Sinead Donnelly is the chairperson of Irish Palliative Care Consultant Association currently and has thought me a lot about the person approach of palliatve medicine.. The art and basic manners in dealing with patient in palliative care.. Dr Marion Conroy is my current consultant, who has taught me a lot on managing the medications in palliative care.. In fact, both have taught me so much in different ways that I am truly grateful to have this experience..
Recently, too, I recieved an email from Dr Ednin Hamzah (CEO and Medical Director of Hospis Malaysia) thanking my interest in palliative medicine in Malaysia.. I sure will consider having palliative care as an interest in my medical career, if not as full time.. Palliative medicine in Malaysia is even younger than in Ireland, only coming to the scene around 1991..
Reflecting on my personal experience as a family member, I realise how magnificent this small moment in providing palliative care service is to me.. My grandmother died a few years back and it is that moment that I keep reflecting on to motivate me to learn as much as I can about caring for the dying.. Had I the knowledge and experience of palliative care at that time, maybe I would have done a little more to the situation.. I could still remember the gloomy air of the situation and the sorrow of the moment..
Dedication
Before I end this entry, I dedicate this writing to my late grandmother, Hjh Zabedah bt Abu Samah, and to my two consultants Dr Sinead Donnelly and Dr Marion Conroy.. I thank my late grandmother who opened my eyes to see the strength required to care for the dying, and I thank my consultants who reminded me that being a doctor is not about curing a disease but caring for a person..
* Art Trivia : In case you haven't noticed, I managed to write this whole entry without using the word drugs, instead I used medicine / medication ~ the linguistic art in palliative care..
* Feel free to visit Hospis Malaysia at www.hospismalaysia.org
Prevention and relief of suffering is another aspect in the definition that may well need a little explanation to clarify.. It is again important to note that the word 'cure' is not being used.. Alas, palliative care is not about curing.. A large proportion of patients under palliative care suffer from intractable pain, or nausea and vomiting.. And these symptoms, more often than not, are clinical presentations of the progression of the underlying disease.. Believe me, they are not pleasant at the least.. By focusing on prevention and relieving these symptoms, the palliative care team hence are focusing on the quality of life.. Many of these patients require morphine to alleviate their pain.. Of note, morphine is the strongest natural analgesia (pain medication) known to man today.. By relieving pain, these patients can potentially spend more quality time with their family members and loved ones.. This is just an example of many..
These all sounded very scientific.. Do not be alarmed.. Palliative care is still medicine, and medicine is science.. The science of medicine is still very much the basis of management.. Palliative care doctors still prescribe medications to the patients.. In fact, I would say, among the physicians, palliative care doctors are among the best to deal with symptoms like pain, comparable to anaesthesiologists! They prescribe large doses of morphine, yet the attention to detail on the calculation of requirement of each patient is meticulously forwarded..
The Art Bit Is Crucial Too
Special to palliative care is the art of it, as do other specialties have for themselves.. The hard part in understanding palliative medicine lies in the question : When do you stop all measure? This is very difficult to understand until we take a while and sit down to evaluate the theme.. When a person is dying, when does the doctor say "no more IV fluid drips" or "stop all other medications"? This next sentence may sound incredibly disturbing, but I will try to explain at my best effort.. Active treatment is stopped when the probability of having a significant response that can improve quality of life is low.. I emphasize the sentence in bold as one read may sound like "washing their own hands".. I give an example of a frail gentleman with widespread lung cancer and currently having a chest infection.. The decision to NOT treat with antibiotics would be made if the general condition of the man himself would not improve despite having antibiotic treatment.. However, if the man was otherwise mobile and relatively well before the infection, then antibiotic treatment may well be tried to give him a chance of fighting the infection.. This is a hard one to call - as a matter of fact, this would be very common in palliative care setting.. The judgment call to treat or not to treat is the art in palliative medicine..
There are many other examples that would call the doctors up to make a decision as hard as - or even harder than - this.. Dealing with family members is another example.. How do you tell that you feel the patient is dying? What would you say when family members ask about the length of time their relative has? Suffice to just throw samples, just for us to ponder.. Many can debate siding on 'to treat' as many as on the 'not to treat' side.. It is still evidence-based, but taking into account the experience of the doctor and the setting of the situation.. The decision-making call is the art as much as it is science..
Palliative Care And Me : Reflection And Ambition
Alhamdulillah, I have been given the short spell of experience working in palliative medicine in Limerick.. At almost six months, I am fairly happy to prescribe morphine intelligently.. I have the opportunity to work with two very experienced consultants in Milford Care Centre.. Dr Sinead Donnelly is the chairperson of Irish Palliative Care Consultant Association currently and has thought me a lot about the person approach of palliatve medicine.. The art and basic manners in dealing with patient in palliative care.. Dr Marion Conroy is my current consultant, who has taught me a lot on managing the medications in palliative care.. In fact, both have taught me so much in different ways that I am truly grateful to have this experience..
Recently, too, I recieved an email from Dr Ednin Hamzah (CEO and Medical Director of Hospis Malaysia) thanking my interest in palliative medicine in Malaysia.. I sure will consider having palliative care as an interest in my medical career, if not as full time.. Palliative medicine in Malaysia is even younger than in Ireland, only coming to the scene around 1991..
Reflecting on my personal experience as a family member, I realise how magnificent this small moment in providing palliative care service is to me.. My grandmother died a few years back and it is that moment that I keep reflecting on to motivate me to learn as much as I can about caring for the dying.. Had I the knowledge and experience of palliative care at that time, maybe I would have done a little more to the situation.. I could still remember the gloomy air of the situation and the sorrow of the moment..
Dedication
Before I end this entry, I dedicate this writing to my late grandmother, Hjh Zabedah bt Abu Samah, and to my two consultants Dr Sinead Donnelly and Dr Marion Conroy.. I thank my late grandmother who opened my eyes to see the strength required to care for the dying, and I thank my consultants who reminded me that being a doctor is not about curing a disease but caring for a person..
* Art Trivia : In case you haven't noticed, I managed to write this whole entry without using the word drugs, instead I used medicine / medication ~ the linguistic art in palliative care..
* Feel free to visit Hospis Malaysia at www.hospismalaysia.org
3 comments:
Assalamualaikum wbt,
Evening my cousin Abg Wok :-)
Thank you for sharing your blog.
Your blog is better than mine ^_^
Wassalam and happy fasting.
Thank you for respond.. Feel free to comment.. Do let us know your blog add..
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