ONCOLOGIST SPEAKS : Breaking the silence: Caregiving in the final stages of patient’s life

What you need to know:

  • Although I love meeting new people, the downside to this kind of a relationship is that from the onset, I am made to realise that the bond is short lived. At one point, I have had to painfully bid farewell to some of my patients - it is not easy.

As an oncologist, I get to know my patients and follow them over a very long period of time due to the nature of their illness. At times, I end up feeling attached to them and their families.

Although I love meeting new people, the downside to this kind of a relationship is that from the onset, I am made to realise that the bond is short lived. At one point, I have had to painfully bid farewell to some of my patients - it is not easy.

When bad incidents happen, such as road accidents or conditions like cancer, we wake up from a slumber, only to realise that death is at our door.

For me and my patients, this is the reality we have to contend with. Initially, there’s an urge to deny the reality that we can fight the battle. However, with time, cancer takes life—and we tend to accept that reality.

In the end, my role as an oncologist is to make the last days of my patient’s life as comfortable as possible. Medically, this is known as Palliative Care.

Knowing when to accept defeat is a virtue that patients need to acquire in their lifetime. And for cancer patients, this is an important virtue.

For a patient who does not stand a good chance of curing the cancer, prolonging life is the best treatment.

Caring for a patient at the end of his or her life is a very important part—not only in oncology but also medicine in general.

This is why even in medical schools we are taught to give counseling to our patients and help their families come to terms with the forthcoming event of losing the loved ones.

In cancer it may seem far more common because of the nature of the disease - slow and painful.

I have observed with dismay when doctors and relatives decide the fate of the patient. But I prefer engaging the patient as much as possible and to respect their wishes or decisions.

In so doing, the patient is able to have peace of mind. Though treatment may be stopped, other forms of treatment such as palliative care, may offer them a painless life.

This includes giving the patients pain killers and other forms of surgery. Surgery aims to relieve intestinal obstruction or improve their breathing.

If settings allow, I usually recommend the idea of home-based care so as to reduce the financial burden of the caregivers and also avail more time for the patient to be near his or her family.

It is also important not to ignore the family members who are, at this stage, trying to come to terms with the reality of death of one of their own. As a doctor, whenever the time and circumstances allow, I reach out and do some counseling.

The ultimatum is when as doctor is feeling the loss just as much as the relatives of the patient. This part is not taught in medical school and nobody dares to talk about it.

We should never shy away from our own mortality, and this is not just for oncologists but also for geriatricians and other doctors.

For many patients, the most important thing is never about survival. Our patients should be asked about their options and in doing so, surprising answers usually arise. They harbor the best answers.