There are no guarantees in life except the certainty that we will die one day. Death Comes as the End, said an Agatha Christie book title, but does it really?
Towards the end of our lives, we would like to be given the reprieve we didn’t get to make many of life’s choices. We would like to be able to decide on how we leave this world: with dignity and a light heart.
For many a palliative care patient, dignity and a light heart are extremely tall orders. How does one go with dignity in a pain-wracked body? Where is the dignity and the lightness of heart?
The LCPC-SHC Postgraduate Course in Palliative Medicine (PGC), co-led by the Lien Centre for Palliative Care and Singapore Hospice Council was first conceptualised with the aspiration to fulfil these tall orders, in order to care for patients with serious life-limiting diseases and their families. Now in its 40th run, LCPC-SHC PGC anchored in its lofty aims, has evolved to meet the growing needs of our ageing society. Originally set up to train General Practitioners, the course has evolved to include doctors across all settings, and Advanced Practice Nurses (APN) — reflecting the increased demand for and complexity of palliative care needs.
Most participants of PGC came with limited supportive and palliative care knowledge. For Dr Chermaine Chee, a participant of the 38th PGC, currently training in family medicine, it was the importance of knowing “how to care for patients both in the pink of health as well as those with severe systemic illnesses or high symptom burden” which drove her to the course.
When asked how the course has impacted their practice, the unanimous answer from the participants was that they are now better equipped to offer comfort and care for patients with life-limiting diseases and their families in a multitude of ways. For Dr Lee Sze Yi (38th PGC) and Dr Adrian Ng (39th PGC), it was growing their confidence in conducting difficult conversations with empathy, and managing patients and families’ emotions. Others like Dr Lee Li Wen (39th PGC) and Dr Rachel Lu (39th PGC) opined a keener knowledge of managing patients’ pain and opioid conversions.
Perhaps what’s compelling is a tacit conviction among participants that death might not be the end: death gives life meaning, and is ironically life changing for those leaving and those left behind. Dr Adrian, Dr Rachel and Dr Li Wen spoke of deaths as dignified farewells, one “which patients live their last days in a manner they prefer” and “with an emphasis on patients, on their hopes and dreams”. At the core of palliative care, the focus is always on the tall orders of “quality of life”, “without judgement”, of light and lightness of heart, and “not death”, quipped Dr Chee.
As the clinician in charge of the programme, Dr Peh Tan Ying hopes that with courses like the PGC, every healthcare professional in Singapore will have the fundamental knowledge and skills to provide basic end-of-life care to patients. Indeed, the programming of the course demonstrated to many such as Dr Akshita Agarwal (39th PGC) that it truly takes a village of “palliative care physicians who work closely with other specialists, nurses, allied health professionals, social health workers, and therapists to provide a comprehensive, holistic medical and emotional/ psychosocial support, not only to patients but also to their families”.
In PGC, we continue to live its pioneering aspirations, that palliative care forges heart work: to offer light and lightness of heart for both its deliverers and recipients. As more healthcare professionals are trained in palliative care, quality end-of-life care for all Singaporeans can become a reality, one which Dr Sze Yi aptly summarised as “LIVING before the farewell”.
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Original article source: Singapore Hospice Council