'Each patient helps to keep me going'

'Each patient helps to keep me going'

SINGAPORE - IN HER her baby pink nursing attire and with her hair in a ponytail, she can be spotted making her daily rounds in the Choa Chu Kang and Teck Whye neighbourhoods.

Clutching her handbag and pulling a wheeled luggage bag, Ms Amy Lim Sock Hui, 46, makes five to six house calls a day.

Wounds are cleaned, medicine dispensed, and comforting words shared with patients and caregivers during each of her hour-long visits.

This has been Ms Lim's routine for the past 4 1/2 years, and she has attended to about a thousand patients and their families over that period.

Except for two patients who beat the odds and became well enough to return to work, none of the rest expects to get better.

Ms Lim is a palliative care nurse and she looks after the terminally ill.

Patient recovery is not a KPI for her. She does her rounds to make dying as comfortable, as meaningful and as dignified as possible for patients.

Today, on World Hospice and Palliative Care Day, The New Paper turns the spotlight on the work and lives of nurses like Ms Lim.

Like many of her colleagues, Ms Lim did not set out to care for the dying when she started her nursing career in 1986.

After stints at several restructured hospitals as a staff nurse, she moved to the private sector and managed a branch of an obstetrics and gynaecology clinic from 1996 to 2006.

Worked for Georgia Lee

Her next move was into the glamour field of aesthetics medicine, where she worked as a therapist for socialite and aesthetic doctor Georgia Lee until February 2008 .

It was during this time that Ms Lim had to deal with the deaths of a friend and of a relative, within months of each other.

Her first glimpse into palliative care came in 2006, when her friend, who was then 42, was dying from colon cancer.

Her friend had a team of nurses who cared for her at home and she died in February that year.

Five months later, Ms Lim was caring for her father-in-law, who was dying from cancer of the pancreas.

She said: "If only I had palliative care knowledge, the care would have been better. I felt that even though I was a nurse, I was still very jittery when I was handling him."

By this time, a switch into palliative care had become a serious option for her, even though there were some very practical concerns.

"I was drawing about $5,000, excluding incentives, during the previous practice, and I would have to take a substantial pay cut with the move," she said.

In the end, it was some strong words of encouragement from a good friend, Dr Tan Chek Wee, who works as a locum doctor in HCA Hospice Care, which gave Ms Lim the courage to switch to palliative care.

In March 2008, she joined HCA Hospice Care as a nurse and started her training in palliative care.

The contrast was stark.

"I went from a palace-like workplace to pounding the streets under the sun and rain. I used to slap on sunblock and moisturiser two to three times a day when I was in aesthetics medicine. Now, it's just sunblock once a day," she said.

But one thing remains unchanged - she still has the same double UV-coated umbrella when she's out in the sun.

A regular work day sees Ms Lim setting off at 9.30am from the HCA Hospice Care's satellite centre in Woodlands, armed with a bag packed with medicine, a blood pressure monitor and other equipment, and her laptop.

Depending on the patients she is seeing for the day, the bag can weigh between 8kg and 10kg.

She said: "There was once when the lift broke down at two blocks where my patients live. I had to lug the bag up the stairs four storeys to one flat and nine to the other."

Ms Lim has about 30 patients under her care and they range from 19 to 94 in age.

Some are mobile and active, while others are bedridden and need feeding tubes.

Her training in palliative care came in useful when she cared for her own father intensively over six years before he died in July.

Parkinson's disease

He had advanced Parkinson's disease, multiple strokes, and was wheelchair-bound for over 14 years.

She said: "I'm more equipped now to know about symptom management. I mapped out an advanced care plan with my dad, which I didn't have with my father-in-law. I also had better knowledge on how to care for him holistically."

Her aesthetics medicine experience also came in handy with a patient in her 40s who had breast cancer and had lost a leg below the knee to diabetes.

She said: "When I saw her for the first time, I had the shock of my life. She was in a pathetic state - her face was bloated and she had a lot of facial hair. She smelled, too."

Among the last wishes of this patient was for her 10-year-old daughter to hug her.

The next day, armed with her cosmetics bag instead of her medicine bag, Ms Lim worked her magic.

She cleaned the patient and got soiled in the process of helping her with her severe constipation. She also waxed off the excess facial hair and trimmed the eyebrows.

It was easy for the daughter to hug her mother after the transformation, and the patient died within two months, said Ms Lim.

There have been bad days too, with one of the worst coming less than two years into the job, in 2010.

It was her first visit to the patient. He did not say a word, but pointing to an open window, he gestured with his hands that he wanted to jump.

Shocked

After checking his medical records and talking to his wife, Ms Lim did not find any indication that he was depressed or suicidal.

But as a precaution, she told the wife to lock all window grilles and keep the keys.

The next day, the wife called Ms Lim and told her that her husband had jumped from his bedroom window.

"I was very shocked. I kept asking myself if there was anything I could have done to prevent it," recounted Ms Lim.

After completing her house calls for the day, she turned up at the dead patient's home.

She said: "If I hadn't gone back and apologised, I wouldn't have had any closure. In the end, the wife was the one who had to comfort me."

To give herself closure, Ms Lim makes it a point to attend the funerals of her patients.

She said: "I think I'm attending more funerals now than weddings.

"I try to attend the funerals, even for a few minutes, to make sure the family members are coping and not grieving excessively."

Teacher Vincent Soh, 36, had his father cared for by Ms Lim in his last days.

Mr Soh's 70-year-old father was diagnosed with rectal cancer in 2008 and died this March.

Said Mr Soh of the work that a palliative care nurse does: "It is a very dedicated profession. It is very psychologically draining because a nurse has to talk to dying patients.

"Preparing patients' family members for death is not easy, especially in our culture, where talking about death is a taboo."

The demands of her job sometimes eat into family time too, said Ms Lim, who has three children aged 10, 17 and 20.

Her work shifts don't always end on time and it is hard not to think of her patients on days off or even dream of them.

But her children and her husband of 21 years, Mr K. H. Ho, 49, vice-president of project management in a real estate company, accept that her work means a lot to her.

And Ms Lim said that there have been no regrets and that the years in palliative care have been the best ones in her nursing career.

So what keeps her going?

She pointed to the walls of her cubicle in her office which were plastered with obituaries, photographs of patients and hand-written letters from them.

"Every one of them has their own story," she said, while going through a clear folder filled with more of such notes and cards from her patients.

She pulled out one written in irregular-sized Chinese characters which read: "Death is imminent, but I must choose the date. It is Chinese New Year and I want my children to celebrate."

The patient who wrote this note lived beyond the 15th day of the Chinese New Year celebrations that year, but died soon after.

Ms Lim said of the letter: "Who would know a blind man dying of nose cancer could write this. Each patient is precious to me ... and helps me to keep going."

More about palliative and hospice care

What is palliative and hospice care?

It is patient-centred care that goes beyond symptom and pain management for people suffering from life-limiting illnesses. This includes advanced cancer, advanced kidney failure, advanced motor-neurone, respiratory, liver, and other degenerative diseases.

Who offers it?

Singapore has 13 organisations that provide palliative care, including five restructured hospitals with in-patient departments.

Eight of them provide hospice care, which includes in-patient care, home care and daycare.

The chairman of Singapore Hospice Council, Dr Akhileswaran Ramaswamy, said there are 50 to 60 nurses who provides palliative care full time at the 13 organisations.

He is also the chief executive officer and medical director of HCA Hospice Care.

Who gets it?

Patients under home care make up the bulk, with 52,797 visits made as of December last year and March this year, due to the different financial year-end of the eight hospice care providers.

In-patient care registered 1,783 admissions and day care has 11,860 attendees during the same period in the same eight hospice care providers.

Who are palliative and hospice care nurses?

They are compassionate nurses who try to provide the best quality of life for patients and their family members, said Dr Akhileswaran.

He told The New Paper: "Many a time, they go beyond their line of duty to do this. "These nurses are special in more ways than one as evidenced by the kind of work they do on a day-to-day basis.

"Letters of appreciation that families send us regularly about the care the patients and their families have received is proof enough of the love, care and compassion that the palliative and hospice care nurses work with all the time."

What is World Hospice and Palliative Care Day?

It is held every second Saturday of October, and the theme for this year is "Living to the end: Palliative care for an ageing population."

To commemorate it, a flea market for the young by the young, called Red Flea Market, was held at *Scape on Saturday.

Celebrities from Fly Entertainment, including Nikki Muller and Bobby Tonelli, put their personal items up for sale.

It is organised by the Singapore Hospice Council and *Scape.

Proceeds from sale of booths to vendors will be shared equally between the two organisations.


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