Her name was Ghina. She was a 40-year old patient diagnosed with late stage cancer. It had spread to all her body. I met Ghina as a rotating medical student on a house-visit with Sanad, an organization that provides home hospice care for terminally ill patients. Ghina was given morphine to ease the pain and was regularly hydrated because she wasn’t drinking any water at the time. Her mother stayed in another room. She was in absolute denial. The doctor on call estimated Ghina only had 72 hours to live, at most, and asked the mother to prepare herself. Ghina died two days later.
Most share the belief that stopping an ailing patient’s treatment is reflective of an attending physician’s perceived heartlessness. The truth, however, can be a different story. As cruel as this might sound, sometimes it is in the patient’s best interest to be off machines, drugs, and hospital care of any form. It seems necessary to reiterate that in medicine, the primary aim is to provide “Health for All”. You’re probably thinking: “But taking a patient off treatment isn’t health.” Yet, the World Health Organization (WHO) would argue against that. The WHO defines health as “the complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Those living their last days, or hours even, in a small, claustrophobic, and oftentimes dark rooms, lying on an unstable bed suffer through unbearable physical pain, mental breakdowns and social anguish, and are thus–according to the WHO’s definition–“unhealthy” despite continuous medical treatment. It is vital, then, to categorize these patients as terminally ill and to shift our focus from medical treatment to comfort care. This practice is referred to as “palliative care.”
In Lebanon, one organization named Balsam provides such treatment to patients in need. In 2015 alone, Balsam admitted 159 patients to palliative treatment. According to the organization, this trend has been on a rise since 2013, suggesting that there has been more tolerance toward palliative care for vulnerable patients and, in turn, more physicians have specialized in this form of treatment.
Yet, there is still a lot of confusion surrounding palliative care. In a society like Lebanon where death is given sacred value, response to palliative care has been mixed at best. Religious interpretations of death give God a decisive role, mostly to assuage individuals of their mortality. In Lebanon, where religion plays a primary role in the public and private life, palliative care can be perceived as an affront. “Only God knows when one is dying,” one might say. And yet, innovations in medicine have helped professionals recognize so-called “signs of death” when examining a terminally-ill patient and coming to the conclusion that medical treatment is no longer helpful. The signs of death include: progressive weakness, sleeping most of the day, difficulty swallowing, anorexia, disorientation, decreased urine volume, inability to close eyes, hallucinations, heavy-noisy breathing. It’s at this point when palliative care professionals take over.
Interestingly, palliative care takes into consideration the family and not only the patient. As a treatment, it follows the logic that easing the pain of the patient is as important as mitigating the suffering of the family members. It provides physical, emotional, and spiritual relief for the entire family. All drugs related to the disease are suspended and symptomatic treatment is initiated. What that means is that the patient receives medication for pain, nausea, and for eased eating and drinking. Agreeably, the hardest is acclimating the family to the inevitability of a loved one’s inevitable death . When the physician starts to identify the signs of death, he/she would initiate preparatory talks with the family focused around the day they’ll have to say their final goodbyes. Palliative care cherishes the priceless value of a human’s life. When experienced medical staff diagnose the patient as being terminally ill/fragile/collapsing, it becomes a duty of theirs to provide ease.
Death is undoubtedly a concept we all, regardless of profession, fear. It is very essential that we build a society that doesn’t feed off the vulnerabilities of the other, and come together to reform the trust in a patient-doctor relationship. Trying to fight the reality of an inevitable mortality, however, is perfectly understandable. The first step towards tolerance is distinguishing between what is best for us and what obviously is not—a matter that perfectly coincides with the general message of palliative care.
For Ghina, palliative care provided a last comfort after a strenuous battle with cancer. It can provide that too for others whose condition is as similarly fragile.
To inquire more about palliative care, contact Sanad or Balsam:
Sanad: 01752142 – 03092634