The Heart of Palliative Care

When she was working as an oncology nurse at a hospital, Koh Ker Sin realised that she did not have much time to engage with her patients and get to know their stories. Today, as a staff nurse of MWS Home Hospice and providing palliative care, she is able to do what she loves: speaking to patients one-on-one and relating to them as individuals. Home hospice work has also allowed her to hone the nursing and diagnostic skills she picked up while studying for a Specialist Diploma in Palliative Care Nursing.

LIKE VISITING A SICK FRIEND AND MORE

Before making a home visit, Ker Sin will usually call her patient to find out how he or she is doing and to check for new symptoms. This enables the home hospice team to prepare for the visit by bringing along the medications needed. Ker Sin treats every home visit like she is visiting a sick friend but providing professional care at the same time.

Besides taking note of the patient’s concerns, she would conduct a thorough physical examination. At the same time, she would look out for emotional and non-verbal cues to identify issues that the patient may not be  comfortable to talk about. Besides providing medical and nursing care, she would also evaluate the patient’s psychological well-being.

After the home visit, she will follow-up with phone calls to check on patients regularly until the next home visit.

THE MOST MEMORABLE PATIENT

One of Ker Sin’s most memorable experiences was caring for an elderly man diagnosed with lung cancer. She visited him twice a week as he suffered from chronic symptoms such as breathlessness and pain. A man of few words, he was quite suspicious of her in the beginning. Then she observed that he had unspoken relationship issues with his wife. Together with an MWS medical social worker, Ker Sin helped the couple reconcile with each other. The patient began to trust and confide in her. He would sit by the window to wait for her if he knew she would be visiting.

Ker Sin remembers vividly the day he died. She had visited him that day but he was not very responsive. His wife had wanted to bring him to the bathroom for a bath but she advised her not to as he was very frail. Instead, Ker Sin kept him in bed and cleaned him with a warm towel while gently holding his hand. She recalls saying to him, “I’m KS. Trust me, I will make sure you are clean and comfortable.” Upon hearing that, he relaxed and allowed her to continue. She then combed his hair, shaved his face, and changed his diapers and bedsheets. When she finished, a tear fell from the corner of his eye as he whispered, “Thank you.”

I felt closure, caring for him during his last hours.

That evening, the patient’s son called to inform her that his father had passed on. At his wake, Ker Sin could see the peace on the patient’s face and sense the gratitude from his family. “I felt closure, caring for him during his last hours,” she said.

A HIGHER CALLING

Ker Sin recalls the first home visit that she had ever made. The patient had breast cancer which resulted in a large fungating wound over her chest wall with metastases to her ribs and lymph nodes. Her left arm was swollen with discharge. Ker Sin watched how the MWS Home Hospice doctor assessed her condition and gently dressed the wound. The expression on the patient’s face showed how touched she was by the doctor’s reassuring words. Ker Sin said, “I was saddened though, and felt that better nursing care could have been given to her earlier to relieve her suffering.”

This and many other experiences in her years in palliative nursing changed Ker Sin’s perspective towards life. “Having patients begin as strangers to trusting me with their lives gives me a sense of satisfaction and achievement. One must truly care about the patients in order to establish trust. Compassion is really at the heart of palliative care.”

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