I once thought of palliative medicine as a field to alleviate pain, to allow unfixable critically and chronically ill patient to be as comfortable as possible. A field that is depressing and with every bit of it relating to death and dying. As a clinician I was really disinterested.
Then came the day when my very own family member was going down the path towards the end of life. This time, I found myself not in the role of a doctor but that of a caregiver, witnessing the withering life of someone I love.
I became the one receiving bad news instead of delivering. This role reversal provided me with a different perspective on palliative medicine—a field that many healthcare workers, like myself, failed to fully understand and appreciate.
So, what is palliative medicine?
Palliative medicine is a journey. A journey where patient rather than the disease itself is the centre of focus. The focus is never about finding a cure but finding the possibility to live the best possible life for as long as possible. A journey where patient and their loved ones will learn about what to expect, ways to manage and how the end might come.
Palliative medicine is about finding hope when everything is at it’s worse. A hope that is realistic and also a question about what is most important now when time is short. It is about allowing the freedom to remain their autonomy for the longest possible while having to reset priorities is life. Sometimes we cannot change the course of event but what we can change is the way we see it. Priorities change when we have a change of perspective.
Palliative medicine is very much about living rather than dying. It is more than just morphine drips, feeding tubes or a referral only when patient is gasping for air. It a field which should be incorporated early so that patient and family would not find themselves in the throes of fears and hopelessness when death is close at hand.
Palliative medicine is about learning and embracing the limitation of modern medicine and frailty of life. Clinicians are taught all along to identify and fix health issues but there will be a time when it is wisest to refrain from fixing the issue. Sometimes damage could be greater when patient battles to the bitter end giving no time and chance to enjoy the important things in life while it was still possible.
Palliative medicine is about giving attention to every single stage of life even when it is nearing the end. It allows people in a state of dependence to sustain their value of existence, allowing the numbered days to be truly lived rather than just surviving. It is about allowing a better death when it is inescapable, inevitable and beyond control. Enabling the life leading towards death to be more meaningful and understanding that there is still more to gain than to lose even when your path is nearing the end.
Palliative medicine is about courage. The courage to have the hardest conversation and to address the greatest fear of every living human. Doctors are not trained enough to deliver news entailing death and we as human will never be prepared enough to face the journey towards the end of life. Addressing the details of eternal rest to patient and family is challenging enough but to do it well requires patience, compassion and the wisdom in communication which no medical school will equip us well with.
Modern medicine and research has made it possible for human race today to experience longer life expectancy, allowing us to live longer than our ancestors. Any news or topics relating to age defying ideas will definitely draw attention. However, regardless how far and wide we search for the possibilities to longevity, our life story will all have the same ending. There will be no life without death.
Why are people less keen in learning about the art of dying well just as much as the art of living well?
I would like to thank Dr Richard Lim in helping me understand his viewpoint, sharing his passion in palliative medicine and guiding me in this write-up. Dedicating this piece of writing to all healthcare workers in palliative medicine and the courageous patients and their family under palliative care.
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