To be a palliative care medical professional does not just involve possessing medical knowledge. A strong passion to help those with advanced illnesses is equally, if not more, important.
Just ask Dr Benjamin Tan and Moira Tan, Agape Methodist Hospice’s (AMH Homecare) Resident Doctor and Nurse Manager respectively.
Learning on the job
“There is no palliative medicine specialisation in medical school. There are sub-specialisations in this area, but only just beginning. So doctors and nurses coming out of mainstream qualifying institutions may not be equipped with the right knowledge about palliative care at first, but thankfully on-the-job training is sufficient when coupled with deep interest. All they need is the willingness to try,” said Dr Tan.
Dr Tan was first exposed to palliative care five years ago, when he was a medical officer at National Cancer Centre (NCC). He recalled accompanying Dr Cynthia Goh, NCC’s Head of Palliative Medicine, on her rounds.
“There were maggots crawling out from the patient’s foot. But the immaculately-dressed Dr Goh didn’t bat an eyelid, and proceeded to roll up her sleeves and clean the affected area. I felt then that the work had deeper meaning as doctors should treat the patient instead of the disease. We don’t aim to cure the terminally-ill, but do everything to alleviate their suffering and discomfort.”
For Nurse Moira, witnessing a cancer patient who was emotionally-distressed transform into a peaceful person after moving to a hospice, opened her eyes to the benefits of palliative care. “I was amazed at the patient’s change as she felt and looked much better. I wanted to learn more about hospice care after that,” she said.
Since then, Moira has never looked back and has been a hospice home care nurse for the past 15 years. Encouraged to offer more to patients and their families, she would regularly attend palliative and pastoral courses to equip herself better. She added: “I’m happy to alleviate their pain symptoms, while providing emotional support and journeying with them to the end.”
But the road has not been easy for Moira. There have been moments of utter helplessness and profound sadness. “Sometimes, the patient’s family is not as caring, or patients are left alone at home to fend for themselves. I worry about them and I try to offer alternative solutions like recommending daycare, but they don’t always work,” she admitted.
Working at AMH Homecare
AMH Homecare has come a long way from its early roots as a pure volunteer movement which started 20 years ago. Today, it has a focused clinical team consisting of a Resident Doctor (backed by locums and other doctors in sister allied healthcare units under the Methodist Welfare Services family), an in-house team of three nurses and a full-time medical social worker.
AMH Homecare is a home care palliative care unit, so its medical team operates flexibly. “Our nurses are able to spend more time with each patient, thereby delivering more personalised care. Moreover, the team meets up weekly to discuss and consult their cases with one another under my supervision,” said Dr Tan.
But more than just offering medical assistance to those with advanced illnesses, AMH Homecare’s medical professionals meet the patients and their family’s biological, emotional and psycho-social needs too, doubling up as counsellors.
AMH Homecare’s strength is in providing holistic support, in line with its past where volunteers augmented its clinical team. “We attach volunteers to our visiting nurses whenever possible, and sometimes, they go on to become good friends with the patients, holding their hands in the difficult journey,” added Dr Tan.
AMH Homecare nurses are encouraged to be more than nurses to its patients. Moira recalled going the extra mile by successfully getting a donor to sponsor a patient’s dentures. “I approached my circle of friends for sponsorship and she was so happy with her dentures. As a nurse, I try to do my best to care for my patients, especially the poor and needy ones,” she added.
A job that makes a whole lot of difference
Dr Tan hopes that more doctors, even general practitioners, will step up to help deliver palliative care to their patients who need such services. He said: “After all, all you need is the interest and willingness to serve. But more importantly, as palliative-trained doctors, you can be the patients’ advocate and speak up for them.”
Very often, all a hospice patient needs is having someone alongside them. “Treating a dying patient might be depressing to some. But to me, if I can help that patient in a meaningful journey till end of life, it will be a good death,” said Moira.
And to be good palliative caregivers, Moira believes that it is necessary to “learn to face your own death”. “Ability to think about our own death and to talk about it with others will enable us to accept our patients’ death better,” she said.