Crossing the boundaries of moral ethics in honouring a dying patient’s last wishes, are decisions that medical practitioners always have to make. This is especially important in terms of balancing patients’ wishes to spend their last days in comfort with their caregivers’ strong desires to keep them alive for as long as possible.
Meet Dr Tricia Yung, Associate Consultant of Palliative Medicine and has been doing it for the past 4 years. Originally dreamed of becoming a gastroenterologist, she was drawn to the values and work of palliative care as a vocation.
How did you first join Palliative Care as a doctor?
Dr Tricia: During my medical training days, I was set up to do something acute in medicine and was well on track to be trained as a gastroenterologist. I almost became one, which was completely different from palliative care. By chance I got to know some people from Palliative Care and came to understand and connect to Palliative Care. I then applied to work in Tan Tock Seng Palliative care as a medical officer. During the second month, I was inspired and fascinated by the team behind it and that’s when I decided I want to care for this group of patients. This group of patients we care for, are more vulnerable. Thus I want to do it long term and that’s when I decided to be in Palliative Care.
If you have 30days left to do what is important?
Dr Tricia: If I have 30days left to live, my priority will always be my family. This is one of the values that my mentor in Tan Tock Seng Palliative Care always encourages us do, which is prioritizing our family members. I was very touched by what my mentor did, when my grandmother passed away and he insisted for me to spend more time at home through this small gesture. I feel that the family values in my department is very strong as my boss emphasises family values and self-care. Part of self-care, is having good family support and social support, with good work-life balance.
‘Think about your own mortality.”
Dr Tricia: I believe that thinking about your own mortality is something that is important. Just the act of thinking about it, is the spirit of ACP itself. In order to have the discussion started, I tried to do ACP at home. But it’s very difficult as my husband ask why I’m doing this. When you are well, people don’t think about such things. I told my husband of how I want to be taken care of when I die. Ultimately it will change as what you think now at the age of 30, will be very different at the age of 60 or 80.
‘We tend to medicalise death and treat death as a failure.’
Dr Tricia: Nowadays we tend to medicalise death and treat death as a failure – which is not true. Palliative care is not rocket science, it can be delivered by anyone and you don’t strictly need to go through special training to deliver basic care. It is very holistic but of course there are certain aspects that will require training. If you dissect the principal of palliative care, boils down to love and care.
When should we begin doing ACP?
Dr Tricia: It is not a contract it can be done anywhere and even casually among friends or famliies as well. The difficulties usually stem from facing very young patients and younger families. Families are coming to terms with the illness and we need to learn to guide them, during this very difficult period.
There was a situation where we were doing ACP with a patient who had poor social support. He treated us as friends and trusted in us. When he was well, we did ACP with him. It came to a point where he had to nominate people and we asked him which family member should we approach but unfortunately he kept rejecting our prompt.We had to proceed even though it’s not in accordance to what he would have wished for.
Unfortunately one day, he turned ill and his children demanded treatment. We had to proceed even though it’s not in accordance to what he would have wish for. It was a tough decision where you know what the patients wish is and having to balance between the family and patient’s wishes. Guilt on the family’s part, may cause them to fight for their own consideration than to consider the patient’s side of the story. Thus we try to pace with the family members and let them know what the patients would have wanted.
How should people broach on death and dying with their family?
Dr Tricia: It is difficult to talk about death and dying. We will all pass away one day and talking about it (death) when you are well is not a taboo. We have to change this kind of mindset, otherwise people don’t see the value of ACP and what’s the point of talking about it if you are well? Death is not a bad thing and maybe then, people will be more ready to talk about it.
The Good Death seeks to transform the negative notion of death itself and is focused on promoting early planning for one’s end-of-life care, especially so for adults over the age of 50. Find out all about The Good Death, ACP and Palliative care here!