Affording a ‘good death’

Palliative care physician James Low, 47, tells Joan Chew how he helps his dying patients live life to the fullest.

The senior consultant and palliative care physician at the department of geriatric medicine at Khoo Teck Puat Hospital became a geriatrician in 2000.

He considers his choice of geriatric medicine as one of the best decisions in his life because he gets to know his patients and their loved ones intimately. He 

In February last year, he was among the first batch of doctors officially recognised by the Ministry of Health as palliative care specialists.

Dr Low's job is to look after the physical, emotional, social, psychological and spiritual needs of dying patients.

Some of his encounters with patients have given him "great faith in the human spirit", he said.

Once, a patient with stage 4 abdominal cancer gave him and a nurse homemade cookies. He noticed a strand of hair stuck to the tape on the cookie bag and knew she was losing hair from chemotherapy.

He recalled: "That strand of hair was a symbol of the suffering she was undergoing. Despite that, she could still spare a thought for others."

His wife works part-time as a senior consultant emergency physician at Alexandra Hospital. They have four daughters, aged 18, 17, 14 and eight, and a six-year-old son.

I specialise in palliative care because...

Humans must be the only creatures to have to grapple with the notion that life is finite and that all must die some day.

Geriatric medicine and palliative care are very humane specialities because they regard the patient as a multi-dimensional being - complex, complicated and, therefore, interesting.

The ageing body is fascinating because...

We still do not know what makes it age. There are many theories of ageing but at the end of the day, it would be multifactorial.

We know that the human body was not engineered to go on forever, but there are some aspects of a human being that do not age, such as personality, intelligence, life experience, wisdom, spirituality and creativity.

Every old person has a history - a story to be told, each one unique and interesting. I always wonder how the old person finally ended up with us in the hospital.

I also admire old people's resilience: Surviving wars, calamities, accidents, injuries, diseases, sometimes abuse and all of life's stresses.

One little known fact about palliative care is...

It is really about life and living it to the fullest. It is intensive care of the dying, about affording a "good death" (an oxymoron) to patients when it arrives.

A good death is one with minimal pain and suffering, in the comfort of the home, in the presence of loved ones, with dignity and with tasks completed.

If I were to give an analogy for what I do, I would...

Be a detective, trying to piece together all the problems of the elderly patient, which are numerous and, therefore, very complex.

I gather the clues from different sources - old case records, medical investigations and what they tell me.

To me, every patient is a mystery to be solved. I love to map out the myriad problems of an older patient and strategise my treatment plans for him.

To some extent, this is like a battle plan and that is why I also feel like a soldier at war.

A typical day for me would...

Start with me being woken up by one of my daughters. I drop three of my five children - who study in five different schools - at or in the vicinity of their schools. I reach work just before 8am every day.

I knock off from work between 6.30 and 7.30pm, and I pick up one daughter along the way home.

It's amazing how some of these kids spend longer hours in school than most adults at work.

As far as possible, evenings are spent at home with the kids. Bringing work back home is uncommon.

I also spend the evenings reading the news on the Internet, listening to my kids play the piano and violin and just trying to talk to all those preoccupied busy souls at home.

Sometimes, I wonder if they have enough time for me at all.

I have come across all types of cases...

From the very well to the dying, from those who still engage in ballroom dancing in their 80s to those in the advanced stages of cancer, having just days to live.

Over the years, I have seen my patients come and go. I have seen how they gradually deteriorate and finally succumb to illnesses.

I have seen how some gradually lose their memory and experience a total disintegration of their personalities; and see the pain and grief that families experience in caring for such patients.

I have seen how just one fall can change the life of an old person forever, leading ultimately to death.

Sometimes, I wish that my patients do not have to deteriorate and die, but it is a fact of life.

It is inevitable that we form bonds with the patients and their families. I feel sad when I come across their obituaries in the newspapers.

For others, I try to attend their wakes as a form of closure.

Often, I wish that I can meet the family members again under happier circumstances.

Things that put a smile on my face include...

Seeing people taking on the arduous task of caring for their elderly parents and choosing to look after them right till the end, at home.

It also warms my heart to see more young doctors taking up the specialities of geriatric medicine and palliative care. These are not the easiest, most glamorous or lucrative disciplines to specialise in.

The rewards are of a different dimension and they are priceless.

It breaks my heart when...

Family members are in conflict at the death bed and beyond. These conflicts could range from the most trivial of things to the more serious ones, such as the type of funeral to arrange and the division of an inheritance.

These take a lot of attention away from the person who matters most - the patient. Every second spent with the dying person counts.

I wouldn't trade places for the world because...

The opportunity to touch someone else's life is an honour and privilege of enormous proportions.

To be of consequence in someone else's life, to make that difference, no matter how small, is something that has to be treasured always.

My best tip...

For those taking care of a sick loved one, please know that this is a great undertaking and a heavy responsibility. But it is the right thing to do and you will never regret it.

The greatest gift our parents gave us was life itself, so the least we can do is to see them off, with love, kindness and generosity.

Our reward will be when we ourselves arrive at that stage of life and when there will be others who will follow in our footsteps and make that bold and courageous decision.

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