28 October 2010
We managed to get an earlier appointment with a medical oncologist while Dad was still in the hospital on 22 October. Our purpose was to get a perspective on his condition from cancer specialist. Also Geok did not think it would serve any good purpose to have too long a gap before the appointment.
We also wanted to seek palliative inputs to manage his symptoms. We also wanted to ask if counseling was available to him should he needed it.
Geok as well as Beng felt that a visit would to the National Cancer Centre would be cathartic for Dad as he would be seeing other patients both young and old. We had planned a good lunch with him and explained to him what would happen at the clinic.
For the first time in so many days, we were all so relieved to hear Dad burped and expressed satisfaction in a meal. Geok had bought sharksfin soup, his favourite.
The journey in the ambulance from Changi to NCC at SGH was quite uneventful. I accompanied him while Geok and Beng went in his cab. I made sure Dad could sit in the vehicle as he had motion sickness the last time he went to the A & E lying down in the ambulance.
We had a pleasant nurse who accompanied us. She kept the journey light - and complimented Dad on his features - sharp nose etc - also that he looked much younger than his 80.
When we arrived at NCC, Dad was pensive but was observing the people around him - for the first time we saw him taking in the different people at the centre - especially the younger patients etc.
The wait was not long - the oncologist who saw my Dad was Dr Mohd Farid - a pleasant and warm person though he was very busy. He did a quick check on the family background etc then made Dad walk a short distance in the clinic and also examined him.
He told us that he would need to re-examine Dad again in two weeks' time - 11.11.10 to ascertain his vitals to see if he would be ready for the follow up palliative treatment. We were very prepared with our questions for him particularly regarding dealing with Dad's discomfort - his back pain; his bloating; his sleeplessness.
Dr Farid started Dad on morphine to help with his breathlessness as well as his pain. It was a good decision cos the few weeks after that was almost non-symptomatic except the breathlessness.
We started our research on the effects of the treatment etc.
Thursday, October 28, 2010
Thursday, October 21, 2010
Our Principles of Care for Dad
When Dad was first diagnosed with cancer on 6 October Everyone of us took the news very badly. While many friends asked how old Dad is and often expressed comfort that he has lived a long life - our perspective at the initial news was - that he is too old to have to suffer this disease.
In the midst of our emotional turmoil and mental anguish, my siblings and I conferred and established three core principles of care for him.
First, medically - we will seek to ensure that Dad receives the best palliative care available - the objective is to have minimal pain arising from his symptoms. The overall objective is to contain any metastasis so as not to impair his quality of life.
Second, lifestyle wise - Dad should be given the best quality of life he can physically enjoy. We will target to spend quality time with him. His level of functionality should be as high as is achievable.
Thirdly, spiritually - we would in our own ways make it a foundation of our care for him. We have Buddhists and Christians as well as Taoists in the family. However, our prayers are consistent - that he should have No Pain, High Comfort and Good Appetite. He should be always filled with happy and positive thoughts throughout most part of the day.
We all agreed that this cannot be achieved without close collaboration and co-operation with the team of doctors. Our principles were also shared with them too.
As children, we are cognizant of the fact that much of Dad's life quality hinges on his mental and emotional states. We can help him achieve a high level of these by showing him our love and concern. For him, it is also important that he not only sees but feels that we are united and cohesive in our approach towards the care of him and particularly Mom.
Financially, I had since a decade ago - signed them up for Medishield (subsequently converted to Incomeshield). We have reiterated this to him so that mentally, he has one issue less to deal with.
Amongst us as siblings, we also have worked out the deployment of our resources so that no one is particularly stretched. Those who are able to render support in whichever way would pick up the slack where the others are unable to.
We are fortunate as the decades of our parents' relatively good health had allowed us to build our careers as well as our financial nest eggs. They have always been the kind of parents who never want to be a burden and bother to their kids - that had given us ample focus on our careers as well as to start our own families, raise our own kids and build our own homes.
In the midst of our emotional turmoil and mental anguish, my siblings and I conferred and established three core principles of care for him.
First, medically - we will seek to ensure that Dad receives the best palliative care available - the objective is to have minimal pain arising from his symptoms. The overall objective is to contain any metastasis so as not to impair his quality of life.
Second, lifestyle wise - Dad should be given the best quality of life he can physically enjoy. We will target to spend quality time with him. His level of functionality should be as high as is achievable.
Thirdly, spiritually - we would in our own ways make it a foundation of our care for him. We have Buddhists and Christians as well as Taoists in the family. However, our prayers are consistent - that he should have No Pain, High Comfort and Good Appetite. He should be always filled with happy and positive thoughts throughout most part of the day.
We all agreed that this cannot be achieved without close collaboration and co-operation with the team of doctors. Our principles were also shared with them too.
As children, we are cognizant of the fact that much of Dad's life quality hinges on his mental and emotional states. We can help him achieve a high level of these by showing him our love and concern. For him, it is also important that he not only sees but feels that we are united and cohesive in our approach towards the care of him and particularly Mom.
Financially, I had since a decade ago - signed them up for Medishield (subsequently converted to Incomeshield). We have reiterated this to him so that mentally, he has one issue less to deal with.
Amongst us as siblings, we also have worked out the deployment of our resources so that no one is particularly stretched. Those who are able to render support in whichever way would pick up the slack where the others are unable to.
We are fortunate as the decades of our parents' relatively good health had allowed us to build our careers as well as our financial nest eggs. They have always been the kind of parents who never want to be a burden and bother to their kids - that had given us ample focus on our careers as well as to start our own families, raise our own kids and build our own homes.
Dad has cancer
Events over the last 16 days came unraveling this morning at 11am. Dad was finally told he has cancer of the lung with traces of the cells in his stomach.
Dad is 80 years old. When I first heard the news - I was devastated. So were my siblings. Crying became a daily routine. We were unsure if we should share the bad news with Dad - we felt he should not know as it might serve no purpose other than to worry him unnecessarily.
His team of doctors from Changi Hospital headed by Dr Seow Chuin - the respiratory consultant and Dr Jeannie Ong, the gastro consultant were of the opinion both ethically and treatment wise -Dad should know. We then decided that we should break the news to him - mainly because we want him to be engaged in the process of his care and treatment moving forward.
I must add that we could not ask for a stronger and better team of doctors. Particularly Dr Seow who has until this morning displayed extremely high professionalism and impeccable bedside manners. Dad himself had complimented him numerous times - even mistaking him to be my friend as he was very caring towards Dad. The same must be said of Dr Ong whom Dad commended for being kind and gentle in her administration of the endoscopy. Dad had expressed reservation to both Geok and me as he recalled his friend's experience some 20 years ago. Dr Ong was able to put Dad at very much ease that he even said he could not recall that it was even done. He also admitted to me that he had recited Nam-myo-ho-renge-kyo under his breath while being wheeled into the operating theatre.
The manner in which Dr Seow shared the news was witnessed by Huat, my 3rd older brother and Geok, my older sister. All concurred that his measured manner of engaging my Dad was indeed helpful.
Dad's health problems started about 1.5 months ago. He had together with Mum who is 81 always enjoyed good health other than the common ailments of aging. In fact, it was only in the past two years that we have had to pay visits to clinics or hospitals with them. For close to 15 years, they had been doing their regular checkups on their own at the polyclinic.
For this - all of us are extremely grateful.
He had at first complained of aches at the right mid section of his back - attributing it to rheumatism. We had brought him to TCM clinics and even physio-therapists as well as consulted his cardiologist.
Symptomatically, the relief was temporary. However, between 2 to 3 October, I sensed that his discomfort of the stomach was getting quite acute. On the morning of the 4th, I then decided to bring him into A & E at Changi Hospital. An X-ray was done and the doctor found his digestive system congested. An enema was done and Dad felt better and we got him home.
In the afternoon, he complained that his symptoms were returning. I asked him if he would like to be readmitted to A & E to get it checked, he declined as our appointment with a gastro specialist was due the following day.
On 5th October, while waiting for his appointment at 2pm, I had begun daily chanting in the morning - setting my target of completing 3 hours so that we would have ample time to make it to the clinic after lunch.
At 12pm, we received a call from the hospital. The doctor from the A & E asked how Dad was doing and when I said the symptoms had persisted, told me that portion of the X-ray that caught the right lung showed fluid. He asked that Dad be brought back to the hospital.
The admission was a dizzy at A & E. Dad was ambulant and lucid. He followed me through the admission process. Upon admission, the team of specialists was called to examine him. The first inkling that we were dealing with something more sinister came when Dr Pinakin briefed me.
He mentioned that fluid in the lung has few possible causes - one it is simply an infection cleared with a dose of antibiotics; the other possibility if tuberculosis - also curable but with a more complex regime of treatment. Finally, he mentioned the word, malignancy (cancer to the lay person).
I was hopeful that it might be just an infection or at worst TB. Dad had TB some 35 years ago - he had related his experience to us before. He was supposed to have succumbed to it because it was a fatal disease then. He also told us that he did not like the quarantine and isolation needed for treatment.
He was saved by a trial drug then. We quipped, more than half serious that both Geok and I would not be here today if the wonder drug had not been introduced then.
A few procedures were carried out for Dad in the interim. Sample of his fluid was drawn for test. Dr Seow who later briefed me on the result was gentler with the news but was more hopeful in his prognosis.
He later ordered a full draining of the fluid - in all, 2.3 liter was emptied. A biopsy was carried out on Dad's lung tissue. Confirmation of advanced adenocarcinoma came one day later - advanced lung cancer in lay terms.
The procedure to extract the lung tissue was in Dad's words, the worst pain of his 80 years of life. Hearing him described it this manner was like a knife gnawing in all us. Dr Seow assured us that it was not the draining of the fluid (as this would recur as the disease progresses). It was the extraction of the lung tissue for the biopsy.
However, Dad's complaints of his bloating and lack of appetite persisted. Doctors were of the opinion that the fluid in his lung was a more immediate issue that needed to be addressed.
Dad is 80 years old. When I first heard the news - I was devastated. So were my siblings. Crying became a daily routine. We were unsure if we should share the bad news with Dad - we felt he should not know as it might serve no purpose other than to worry him unnecessarily.
His team of doctors from Changi Hospital headed by Dr Seow Chuin - the respiratory consultant and Dr Jeannie Ong, the gastro consultant were of the opinion both ethically and treatment wise -Dad should know. We then decided that we should break the news to him - mainly because we want him to be engaged in the process of his care and treatment moving forward.
I must add that we could not ask for a stronger and better team of doctors. Particularly Dr Seow who has until this morning displayed extremely high professionalism and impeccable bedside manners. Dad himself had complimented him numerous times - even mistaking him to be my friend as he was very caring towards Dad. The same must be said of Dr Ong whom Dad commended for being kind and gentle in her administration of the endoscopy. Dad had expressed reservation to both Geok and me as he recalled his friend's experience some 20 years ago. Dr Ong was able to put Dad at very much ease that he even said he could not recall that it was even done. He also admitted to me that he had recited Nam-myo-ho-renge-kyo under his breath while being wheeled into the operating theatre.
The manner in which Dr Seow shared the news was witnessed by Huat, my 3rd older brother and Geok, my older sister. All concurred that his measured manner of engaging my Dad was indeed helpful.
Dad's health problems started about 1.5 months ago. He had together with Mum who is 81 always enjoyed good health other than the common ailments of aging. In fact, it was only in the past two years that we have had to pay visits to clinics or hospitals with them. For close to 15 years, they had been doing their regular checkups on their own at the polyclinic.
For this - all of us are extremely grateful.
He had at first complained of aches at the right mid section of his back - attributing it to rheumatism. We had brought him to TCM clinics and even physio-therapists as well as consulted his cardiologist.
Symptomatically, the relief was temporary. However, between 2 to 3 October, I sensed that his discomfort of the stomach was getting quite acute. On the morning of the 4th, I then decided to bring him into A & E at Changi Hospital. An X-ray was done and the doctor found his digestive system congested. An enema was done and Dad felt better and we got him home.
In the afternoon, he complained that his symptoms were returning. I asked him if he would like to be readmitted to A & E to get it checked, he declined as our appointment with a gastro specialist was due the following day.
On 5th October, while waiting for his appointment at 2pm, I had begun daily chanting in the morning - setting my target of completing 3 hours so that we would have ample time to make it to the clinic after lunch.
At 12pm, we received a call from the hospital. The doctor from the A & E asked how Dad was doing and when I said the symptoms had persisted, told me that portion of the X-ray that caught the right lung showed fluid. He asked that Dad be brought back to the hospital.
The admission was a dizzy at A & E. Dad was ambulant and lucid. He followed me through the admission process. Upon admission, the team of specialists was called to examine him. The first inkling that we were dealing with something more sinister came when Dr Pinakin briefed me.
He mentioned that fluid in the lung has few possible causes - one it is simply an infection cleared with a dose of antibiotics; the other possibility if tuberculosis - also curable but with a more complex regime of treatment. Finally, he mentioned the word, malignancy (cancer to the lay person).
I was hopeful that it might be just an infection or at worst TB. Dad had TB some 35 years ago - he had related his experience to us before. He was supposed to have succumbed to it because it was a fatal disease then. He also told us that he did not like the quarantine and isolation needed for treatment.
He was saved by a trial drug then. We quipped, more than half serious that both Geok and I would not be here today if the wonder drug had not been introduced then.
A few procedures were carried out for Dad in the interim. Sample of his fluid was drawn for test. Dr Seow who later briefed me on the result was gentler with the news but was more hopeful in his prognosis.
He later ordered a full draining of the fluid - in all, 2.3 liter was emptied. A biopsy was carried out on Dad's lung tissue. Confirmation of advanced adenocarcinoma came one day later - advanced lung cancer in lay terms.
The procedure to extract the lung tissue was in Dad's words, the worst pain of his 80 years of life. Hearing him described it this manner was like a knife gnawing in all us. Dr Seow assured us that it was not the draining of the fluid (as this would recur as the disease progresses). It was the extraction of the lung tissue for the biopsy.
However, Dad's complaints of his bloating and lack of appetite persisted. Doctors were of the opinion that the fluid in his lung was a more immediate issue that needed to be addressed.
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