A night in the palliative ward

It was my turn to be on call during Easter. My pager went off shortly after midnight. “Lawrence, one of our patients is crashing. We need your support here,” the nurse from the palliative ward said. A woman in her 80s was dying and her family was not ready to let her go. A couple of family members were emotionally upset.

Upon arrival on the ward, I checked with the staff before entering the room. Mrs. G had end-stage renal disease. This woman had been on hemodialysis for more than 15 years and had recently withdrawn voluntarily from the treatment. As a member of the interdisciplinary team, I had met her once during an ethical consultation session. “I have had enough of this [dialysis] and I am ready to go to heaven,” she said. Admission into the palliative program meant there would be no extraordinary treatments while pain management was implemented to prevent unnecessary physical, psychological, and spiritual suffering.

A few family members had difficulties dealing with her dying process. She had a solid faith in God even though she had not been to church for years. When I entered her room, there were scores of family members around. I spent some time with a few, listening to their anticipatory grief. Those gathered read Scripture and offered prayers as family members said their goodbyes one last time. Mrs. G soon passed away peacefully. Afterward, we sat down in the comfort room, taking turns to tell our favourite stories and memories with Mrs. G. It was a bittersweet moment for many. In a way, we were relieved she was no longer suffering, but on the other hand, we missed her presence.

What is palliative care?

According to the World Health Organization, palliative care is a medical approach that improves the quality of life of patients and their families as they face life-threatening illness. It is about tending to patients and families holistically by preventing and alleviating suffering. The Latin word palliare denotes the action of cloaking someone – an act that comforts and cares.

Palliative care offers an alternative to curative measures when death is imminent. It provides adequate control of pain and other medical symptoms while maintaining the dignity of individuals. Palliative care is not euthanasia. It does not promote the suspension of all medical treatment.

In most instances, medical measures are given to palliative patients for pain and symptom management.

The trajectory of palliative care is not limited to the patient herself. Since family members are equally affected in this process, psychosocially and spiritually, supportive care is given to patient and family members as a single unit. Appropriate palliation provides adequate information and time so that patients and families can set realistic goals in terms of care. It also gives them time and space for open, honest, continuous dialogue over unresolved issues. For many, it is also the time to reconnect, even reignite their relationship with the Lord. One of the privileges of being a Protestant chaplain at the hospital is to witness the miracle when someone “makes right with God” as they prepare for this final journey on earth.

Honouring and protecting the weak and vulnerable

The first step of being human is to accept mortality as reality. Yet we live in a world where death and dying is still very much a taboo subject. There aren’t many of us who are fully prepared for our loved ones to die, let alone accepting of our own mortality. Advance conversations on death and dying are rare in our culture; this is even true among Christian communities.

The advance of modern medicine gives people more mileage with their health. However, the same technology potentially prolongs unnecessary sufferings of those in an incurable stage of their disease.
Many years ago, I met an elderly lady who had an inoperable tumour and all therapeutic interventions had failed. She was admitted after multiple convulsions. During one of my visits, she confessed to me her longing for heaven. Unfortunately nobody understood her as they urged her to have “more faith in her God.” To this woman, there was more suffering being alive than dead. Palliative medicine provides a platform where patients are treated as real people, where their dignity and wishes are honoured and respected.

Terminal illness carries much more than the dysfunction of the body. Existential angst often occurs as one deteriorates.

The search for meaning, the quest to answer the suffering question, and life-review are daily subjects in patients’ thoughts. With the help of palliative care, we are given the chance to experience our finiteness, secure in God’s infinite love.

A healing presence to the dying

As a chaplain, my role associates with the spiritual well-being of patients and families. My involvement in palliative care includes regular visitations, ethical consults, crisis interventions, and staff support. While palliative patients are often fatigued and have no energy for long conversations, many long for a pair of listening ears. The process of being listened to, acknowledged, and remembered is a healing journey.

Every single palliative patient has unfinished business to deal with. Issues of identity, self-worth, forgiveness, reconciliation, loneliness, and spiritual depression – even anger with God – are discussed. Sometimes patients’ concerns are not for themselves but the well-being of their loved ones. Contrary to popular beliefs, chaplains do not provide answers to every question or fix all the problems. The call, and the privilege, of a hospital chaplain is to provide a presence to those in need during their journey, and it is our assurance that the Holy Spirit comforts and grants peace and reconciliation to those who are ill.

If the goal of palliative care is for the patient to be healed by becoming whole, then it is impossible to neglect spirituality. For those of us secured in Jesus’ love, we can trust that our lives will be whole when we enter our true home, the eternal presence of God.