There is a lesson to be learnt from every patient, and it helps to have an open heart and a patient ear.
Palliative care is about adding meaning to patients’ remaining time with us. When we make a positive impact, these are the memories patients reflect on at the end of their lives,” shared Assistant Nurse Clinician Kimberly Lim.
These patients are a part of Yishun Health’s Ageing-in-Place programme, a service that supports patients in their care transitions from hospital to home through home visits and tele-support. Since Kimberly started her journey as a community nurse in 2012, she has provided palliative care to patients of different ages from 40 to over 100 years old. To Kimberly, each of these patients has a story that offers lessons that have enriched her perspective.
LEARNING WHAT MATTERS MOST
News that the end of life is approaching could at times renew one’s sense of priority for what matters most.
Kimberly recalls a heart failure patient in her 60s, for example, who kept herself busy with gardening, and arts and crafts every day, and even made the effort to keep up with current affairs on the radio. She had a strong sense of purpose for what mattered to her — not being a burden to her sister, whom she lived with.
With independence at the top of her mind, the care team assisted her to apply for a walking aid and reduced the swelling she experienced so she could be as mobile as possible. A medical social worker also facilitated her application for financial assistance. The lightening of the financial burden offered a great deal of comfort to her in her last days.
LISTENING WITH THE HEART
Kimberly reflected that her younger patients were often more communicative about their wishes and plans. This also extended to their interest to understand the details of their condition. In contrast, the family members of older patients were often the key decision-makers, especially if the elderly patients were non-verbal as a result of their medical conditions.
However, this did not mean that older patients did not have goals or preferences. Kimberly recalls her oldest palliative care patient — a then 102-year-old gentleman. When she visited him at home, she saw that he had a bad temper and refused to cooperate with his family members. As the patient was on nasogastric (NG) feeding tube and on tracheostomy tube for breathing, he could not communicate verbally. To understand his views, Kimberly therefore made observations of his behavior, and had several conversations with his family members. She then realised that he was upset about being moved out of his home to live with his son. What mattered most to him was spending more of his remaining time at home, where he had memories with his late wife, whom he still missed dearly.
Kimberly and her colleagues then facilitated conversations with his family so that he was able to spend more time at his own home, giving him the motivation and hope to keep going. In this case, it was crucial to listen with not just the ears, but also the eyes and heart.
LIFTING UP TO CARRY ON
When a loved one nears the end of life, family members are often affected not just emotionally, but also where the practical aspects of life are concerned. This is doubly so when a patient is at the prime of his life.
One of Kimberly’s palliative care patients was a man in his 40s who had experienced a sudden heart attack, leaving him unable to communicate and dependent on full-time care with minimal chance of recovery. He was the sole breadwinner and at the time, was thinking about starting a family. For his wife, this meant not just the profound loss of a loved one, but also of shared goals and dreams. It also caused an upheaval in her life with the shift from being a housewife, to breadwinner and caregiver. For the first time, she was faced with the prospect of searching for work that could pay the bills and support them.
“We really needed community social support — counselling support and an ongoing social worker — to journey together with the family, and help his wife to plan for the future,” shared Kimberly. “This is a unique aspect of care for patients at this age.”
After years of experience as a community nurse, Kimberly has been confronted with numerous difficult situations. “There were times when I was at a loss. But, just by going through this journey with the patients and their families reassured them that they are not alone. They have someone to hold their hand and listen to them,” Kimberly said.
As every case is unique, Kimberly has gained new and broader perspectives in the process of walking with her patients. “Providing palliative care has enriched my life,” she explained. “I experience different moments of my patients’ lives together with them, and each experience prepares me to manage my future patients.”
Photo: Tan Shi Hui