Palliative care: Easing the pain of the terminally ill

MANILA, Philippines - As modern lifestyles evolve rapidly nowadays, so have the practice of family health and medical management. Gone are the days when frustrated relatives have little recourse but to watch passively as heroic measures are applied to save a stricken family member suffering great pain or distress because of an advanced or incurable illness.

 This is a health and family issue that comes to mind as I recall how our family was able to sidestep a potentially harrowing experience in 2008 when my wife went through the terminal phase of her bout with breast cancer. When the end came, Lita was able to pass on, we’d like to think, without too much suffering.

 Our attending medical oncologist at Cardinal Santos Medical Center (CSMC), Dr. Valorie F. Chan, graciously opened access to what at the time was close to state-of-the-art therapy for Lita’s cancer, yet to no avail. Our surgical oncologist, Dr. David Y. Dy, anticipated the unraveling situation after learning that Lita had been released from treatment and discharged from hospital, which to us was the unwritten riot act.

“Let me get you in touch with a pain management and palliative care specialist,” said Dave Dy. “It will reduce the distress for Lita and also for the family, for everybody.”

 At this point, Dr. Luzviminda S. Kwong came into the picture, providing a combination of gentle, soothing, medical and psycho-social interventions that significantly eased the difficulties not just for Lita but also for us in the close family circle.

 Dr. Kwong is a tireless advocate of palliative care. She obtained her medical degree at the University of Santo Tomas and finished her specialization as an anesthesiologist at the University of the Philippines-Philippine General Hospital in 1993. This was followed by a subspecialization as a pain specialist at St. Luke’s Medical Center in 1995.

 When I visited the recently-opened CSMC Pain Management and Palliative Care Section, I realized the paradox of how palliative care differs from other medical specializations.

 With other medical specialties, the narrower the focus of practice, the more expert and learned the specialist is deemed to be. In palliative care, however, the reverse seems true: The more well-rounded and versatile the practitioner is, the better the prospects will be for the patient and the family.

 This is because, by nature, palliative care involves a close interplay of various disciplines addressing a complex situation that includes symptom management; care in the psychosocial and spiritual aspects; support for the processing of grief and bereavement; communication and, depending on the circumstances, even legal and ethical concerns.

 This brings me back to those last few days with Dr. Kwong taking charge of my wife’s care at home. How thoughtful of Doktora, I reflected, to spend much time with me discussing so many peripheral issues and concerns not immediately related to Lita’s condition.

 Dr. Kwong patiently guided us on the specifics of pain relief — how to administer maintenance dosages of pain medication, how to give so-called rescue doses if there was a spike in perceived pain, even how to clean the bed sore in a way that would be less traumatic for the patient, etc. But beyond these tips, it was her conversations with us about how we are coping, and her pointers on adjusting and adapting, that pepped us, who were the principal caregivers, to become stronger and more confident to face the traumatic and difficult days ahead.

 Sure enough, barely 72 hours after Dr. Kwong shared another batch of guidance with me, I found myself riding the wave of the near-death scenario. Even though the end came two weeks premature, I felt no panic as I spent the last seven hours by Lita’s side. Though unwilling and refusing to accept, I was not caught flat-footed. I was able to keep my emotions in check, thanks to Dr. Kwong’s gentle ways over the past couple of weeks priming me up for the crucial final moments.

 There is a huge difference between a gentle, dignified passing and one ridden with terrible and prolonged suffering. As Dr. Kwong puts it, “The goal is to provide the best quality of care and make death with dignity possible as patients approach the end of life.”

 A person dying is never the only person who is affected by the illness and the death. The family is really going through it, along with the seriously ill or dying loved one. Helping the family, not just the patient, is the one huge benefit that the practice of palliative care provides.

 When Cardinal Santos Medical Center recently opened its Pain Management and Palliative Care Section as part of the CSMC Cancer Center, I was invited by its section head Dr. Kwong who wanted to touch base again with members of my family.

 In her refurbished office, Dr. Kwong points out to me that being a relatively “new” special field of practice in the country, “palliative care can still connote different things to different people, even among physicians.” 

 She adds,“The underlying motivation, however, is not unique. With its goal of relieving symptoms and meeting patient goals, palliative care is definitely an approach that those near the end of life or suffering from incurable conditions can benefit the most from.”

 She describes herself as the type who always wants to connect deeply with her patients: “During my training, when I was rotated to pain management, I liked it because I could ask, examine, and converse more thoroughly with patients to discern their psycho-social and emotional status.”

 She goes on to relate, “So, after my anesthesiology residency, I applied right away for further study in pain medicine at St. Luke’s Medical Center, where I could gain experience in a private hospital venue to round out my previous exposure to a teaching pontifical hospital (UST) and a state-run teaching hospital (PGH).”

 What made her happier, Dr. Kwong remarks, was that she got to be trained not only in the out-patient and in-patient settings but also right in the patients’ comfort zone, which was in their home.

 And now, Luz Kwong is deep into helping provide relief to those in bad pain, for many of whom practically nothing can be done anymore. “Almost all of my patients are dying,” she discloses, “but I know I can still help them in the remaining months, weeks, days or hours of their lives.”

 These days, illnesses or disorders that kill, like cancer, stroke, chronic obstructive pulmonary disease, and congestive heart failure, or even dementia, often involve a prolonged time of disability and suffering before death. Dr. Kwong says that she has seen “too many suffering patients live and die in pain and having to experience distressing or uncomfortable events. It is ironic that such a scenario persists in a modern era of technological advancement such as ours.”

 More than once, she adds, she couldn’t help thinking that for many of her patients, living longer doesn’t quite equate to dying better as many of them have to go through terrible suffering, if not for pain management and palliative care.

 Clarifying that it was not the intention of the modern health care system to create a terrible system for the terminally or chronically ill, Dr. Kwong explains that the system seems to be oriented more to handling emergencies and immediate concerns, diagnostic tests, and other short- or medium-term issues, “but needs to more substantively address the protracted needs of the chronically ill or the dying.”

 It is in response to this quality-of-life concern that the Cardinal Santos Medical Center’s Cancer Center went ahead to establish its Pain and Palliative Care Section. Under the leadership of Dr. Luzviminda S. Kwong, the section offers a wide range of services, including pain management and nutrition management, spiritual counseling and psychological support including pediatric patients.

 The section provides out-patient consultations and in-patient management as well as home care management. It is staffed by five pain specialists, a palliative care specialist, three nutrition doctors, a spiritual counselor, a child life specialist, a patient coordinator, a staff nurse, and a pharmacist.

 With pain management and palliative care now being provided by modern health facilities like Cardinal Santos Medical Center, the suffering is eased not just for the patient but for the family of the patient as well.