The Joy of practicing Palliative Care

Following my house-job in Radiotherapy, I decided to pursue my professional career in Oncology. My professor immediately warned me of the paucity of work in 1986 – 87. Despite the challenges in technology (limited availability of CT scans, radiotherapy equipment and planning aids) and the myriad psychological issues faced by cancer patients and their care givers, I was not deterred towards completing my training. Subsequently, I chose to work in small and tier B cities, which were plagued by resource constraints (facilities, ignorance and financial capacity). The challenge here was in being able to provide ethical and evidence-based cancer treatment. The ability to care for patients from such resource strapped areas along with my efforts with Youth against Tobacco, I found satisfaction in both my work life and personal life.

I now feel that it was nothing short of a miracle when I found out about and arrived at Kalimpong, in North Bengal, which has a large population of elderly people many of who are over the age of 75 years. As anywhere else in the country, here too, most cancer patients reach the hospital in advanced stages where oncological approaches are not indicated or useful. I realized then that Palliative medicine and care was required by a large population in this region but was not often available or understood among the general community. This prompted me to enroll myself into a training program in palliative medicine. After successfully completing my ‘National Fellowship in Palliative Medicine’ from IPM, Kozhikode, Kerala, I have been practicing palliative medicine for the last 2 years.

On the occasion of ‘International Day of Happiness’, I share with you below, a few wholesome professional experiences which has brought me immense joy and satisfaction.

Ms Priya (name changed), my 87-year-old neighbor was bed ridden with a host of medical conditions including a fracture of her hip bones. Her wish was to be cared for at home. Upon learning this, I was able to connect with my alma matter, IPM, who helped me to relieve her suffering. A year later, her family reached out to me to provide end of life care for Ms Priya’s 92-year-old husband, who had begun to reduce his food intake. After his last rites were completed, Ms Priya’s eldest daughter gave me a card which really touched me: “Thank you for always being available. Thank you for sharing our pain”.

Let’s now meet Mr Rahul (name changed), a patient of metastatic pancreatic cancer. When I met him, he was suffering and was in severe pain. I learnt that he was a firm believer in God. Post evaluating him and with inputs from his family members, we realized that the major portion of his pain was contributed by his spiritual pain and distress. Over the next few days, our team addressed it which allowed him to be comfortable and at peace within the comfort of his own home for the next 44 days, until he breathed his last. Mr Rahul’s daughter-in-law, then shared, “I sure am indebted to you and ma’am for bringing love, warmth and hope into our lives. Also, I am thankful to your entire parish and especially Fr. John SJ. God was present amongst all of us on that last afternoon.”

The final interaction that I wish to share is that of Mr Abhijit (name changed). Mr Abhijit was diagnosed with hepatocellular cancer in 2018. All was well for 5 years after his disease directed treatment was completed. In 2023, his cancer relapsed and he was referred to his home town, Siliguri, for Palliative radiation as pain relief for metastasis of his hip bone. We evaluated him at home as he was bed ridden. His family was also very co-operative and understanding. After my first interaction with Mr Abhijit, he said, “This doctor never once saw his watch or mobile while he was with me. I was therefore able to share all that I wanted to say.” After this interaction, his family told me that he ate and drank a little which he was refusing to do earlier. Mr Abhijit and his family also consented to the care plan that we developed jointly to provide palliative care for Mr Abhijit at home instead of the radiotherapy route which was neither beneficial or practical to provide him with pain relief. The next week was one of sharing joy, laughter and fulfilling all his desires! His younger son sent me the following WhatsApp message when he passed away, “Even the last painkiller that you gave seemed to have exhibited its effect. He became peaceful and was awake for some time towards the end.”

Death, is sure to knock on the lives of everyone.

Before entering the world of palliative care, my only encounter with death was while writing death certificates or while participating in the last rites of my near and dear ones. Now, as a palliative care professional, I have prolonged engagement in end-of-life care with patients and their care givers, which also extends into bereavement care. My perspective of death has now changed. The result is my trust of the unknown and a new understanding of my faith.

By practicing palliative medicine, my outlook towards the needs, desires, and demands of patients and particularly the care givers have become more unbiased and open. Empathy, understanding, and acceptance, are the new standards which has helped bring a new delight to my work. Ever since I forayed into palliative care, even my daughters and wife say “You seem to be more at ease and full of happiness these days”. This my friends is the power of palliative care.

I invite and urge every clinician to get acquainted with this very important and much needed branch of medicine and incorporate it into one’s practice or better still pursue it as one’s specialty. Let us all strive to alleviate the suffering of patients and caregivers in our day-to-day practice.

About the Author:

Dr Pankaj Chowdhary is a Practicing Clinical Oncologist for 36 years. He has been practicing Palliative Medicine for the past 2 years.

He was passionate about chess and Marathon during his student life, and his colleagues at Medicine school referred to him as ‘Captain’. He enjoys reading now. A Patron of VoTV (Voices of Tobacco victims), he also has particular interest in children and the elderly.

Note: This article is a republication from the March 2024 edition of the Indian Association of Palliative Care’s (IAPC) e newsletter.