“I can’t stand this pain any longer.” The words stopped me outside the privacy curtain. A while earlier, a colleague called, frantic with worry, and asked me to see a patient who was in severe pain. She was crying and, at times, screaming in agony.
I drew the curtains back to find her curled on her side. She held her knees against her chest, the blanket tangled around her.
Foetal.
Working with my consultant, we identified the cause of her pain and adjusted her medications. She fell asleep. There was much more to understand about this woman but that would have to wait.
At thirty-six, Harini had stage four colon cancer. Surgery and two lines of chemotherapy failed to contain the disease. The cancer had spread beyond the bowel to her pelvis and spine, and she was living with pain that seemed resistant to everything we tried.
Before cancer, Harini’s life centred around her children. A familiar routine filled her days. She packed school bags, prepared lunch boxes, dropped them off at school before returning to her chores at home. When they got home, it was time for homework and tuition classes. Their dinners were simple, shared together at the table while she listened to their endless chatter.
It exhausted her. It also meant everything to her.
She spoke often about her two children. Even on difficult days, her face brightened when their names came up. By then, the children were already used to their mother moving in and out of hospital. Cancer had been part of family life for almost two years, but this admission was different. It had stretched on for almost a month, the longest separation they had endured.
“They still ask when I’m coming home,” she told me after one video call, tears gathering in her eyes.
Harini’s husband visited every day. His evenings were entirely hers. He struggled to manage the household alone while continuing to work. The cost of caregiving crept up on him, almost without notice. He appeared weary most of the time, his shirts a size too big for him now.
Our conversations unfolded in fragments over several weeks. Between medication reviews and brief stretches when the pain loosened its grip enough for conversation, a fuller picture emerged. She worried about finances, as her husband had cut back on work to care for her. The future they had imagined together was no longer theirs to plan. She wept knowing she wouldn’t be there for her daughter’s first day of secondary school, nor would she see her son earn his black belt in karate.
“Why me?” she asked one day.
Although her pain scores improved on paper and we appeared to be making progress, our conversations always returned to the same place. Then one afternoon, after a long silence, she looked at me and said: “The children need me.” The words echoed in my mind for the rest of the day. There isn’t a scale that could measure that kind of pain.
It was the school holidays by then. After discussing the plan with Harini and her husband, we arranged for discharge with support from the community palliative care team. It felt ambitious. She remained frail, facing readmission within days.
Yet, every day in hospital was a day she wouldn’t get back with her children. On the day she left, I handed her a small bag containing fruit and chocolate wafers. She looked surprised.
“The children are home for the school holidays,” I said. “I thought it might be nice to bring them something.” Despite everything, Harini smiled.
A week later, Harini returned to the outpatient clinic. She was almost unrecognisable. Gone was the exhausted woman who had cried in the cubicle.
She sat upright in a wheelchair, dressed in fresh clothes and hair smoothed into place. A handbag rested on her lap. She told me about the week they shared playing board games, watching television in the evenings and enjoying their favourite meals.
Then, with a shrug, she said: “The pain is bearable now. I don’t need so much medication anymore.” She had reduced her doses at home, without consulting anyone.
I remember sitting there, surprised. It did not make sense to me. My mind immediately went to the medications. Had I missed something? Was there a change I had overlooked? While I searched for a medical explanation because that was the framework I knew best, her descriptions of her week at home made those explanations feel less convincing.
Looking back, I realise how I defaulted to viewing her suffering through the lens of symptom control. My instinct was to find the best drug for her and to optimize the dose.
I turned to the physiotherapist and the occupational therapist, hoping the combined approach would further reduce her pain.
Yet, Harini taught me to look wider. Suffering does not always yield to medication. Sometimes what hurts most is being separated from the people and roles that give life meaning.
Harini died a few weeks later. Not as a patient in a hospital, but as a mother to her children.
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Dr Ruben Vighnesvaran is based at the Palliative Care Unit, Raja Permaisuri Bainun Hospital in
Ipoh, Malaysia. He cares for patients with advanced illness and supports families through
difficult decisions at the end of life. He writes reflectively about these encounters, sharing his
work in his Facebook page, Always Something More-Reflections in Palliative Care.
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