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Ending by design: a lesson in life and love

We sincerely wish to empower the patients to live their very best lives in the way that they wish to, even when it seems like there is not much under their control as the end approaches. Together, we can make this a beautiful ending.” said Dr. Jinda Udompanyawit, the Senior Coordinating Physician and Family Therapist at Bumrungrad Hospital.

It is Dr. Jinda’s sincere belief that the key to understand others lies in empathy and deep listening. “When people sense that we truly care for their wellbeing, everything goes a lot smoother,” explains Dr. Jinda. As the Senior Coordinating Physician, it is Dr. Jinda’s job to ensure that all medical professionals and teams, in-house or external, are working in concert to provide the best care experience possible to patients and their families.

Most international cancer patients already have some adjusting to do when they seek treatments in Thailand, since the Thai healthcare system might be quite different from the healthcare systems of their native countries. “Having cancer is already mentally and emotionally challenging enough for a patient. It is the job of our coordination team to ensure that our healthcare professionals, patients, and their families can interface and collaborate seamlessly, to create and execute the best treatment plans possible for each patient,” explains Dr. Jinda.
 

Every patient has different emotional needs

As a Marriage and Family therapist, Dr. Jinda understands well that the diagnosis of a serious chronic condition is a life-changing event for anyone and their family. The emotional equilibrium of the family can be severely shaken, which can profoundly affect the treatment itself. It is therefore extremely important to provide psychosocial counselling to patients, their spouses and family, and even the healthcare professionals involved in their treatment.

Here is a previous case where this approach contributed greatly to successful treatment. “I once had a patient from India. Her husband was extremely anxious and temperamental, constantly making very emotional demands for this or that.” With patience and understanding, Dr. Jinda eventually gained the trust of her patient. She could see that the patient’s husband was simply trying his best to ensure that everything possible was being done whenever his wife began to feel hopeless.  He thought that calling for drastic changes in treatment would help to solve the problem and reassure his wife. Unfortunately, he ended up stressing his wife out even further. The turning point came when the patient experienced persistent shortness of breath which refused to improve despite changing doctors and medical teams. Her husband had to go home to care for their children during this downturn, leaving his wife all alone and afraid in hospital. Dr. Jinda seized on the opportunity to show them a different way of thinking. She recommended that the husband sit quietly beside his wife, and to the couple’s surprise, the patient’s oxygen level gradually improved without any medical intervention. He came to see that by trying to take an active role in everything he was actually stressing her out and impeding the work of her doctors, and that just by being by her side led to an improvement in her overall physical condition.


Palliative Care

Previously a term for the final stages of care for terminal cancer patients, palliative care now has a new definition thanks to the advanced cancer treatment at Bumrungrad Hospital’s Horizon cancer treatment center. Combined with immunotherapy and excellent physical care for the patient, moving palliative care to the earliest stages of treatment can lead to a marked improvement in the success of treatment.
 
“Before, patients would be transferred to palliative care specialists only when the patients reached the terminal stages. Now, we have created similar teams to provide the same standard of physical and emotional care during the early stages, because we know that the beginning can be very difficult and stressful for patients and their family members, who are trying to come to terms with the diagnosis.”

By forming close relationships with the patient and their family, the team establishes a close bond of trust that will greatly benefit treatment, should things progress to the terminal stages.

“Prior to reaching that stage, we provide counselling to the patient and family on the things to come. We help them to process any issues that may remain in their lives, discuss their life goals, their fight against this serious illness, their stress, and their pain. We let them all know what to expect. We talk about when enough is enough. We help the family to decide whether to keep life support going and try to revive the patient. We allow the family members to express their views, which may well differ. The best thing about this is that family members get to feel that they’ve done everything they can for the patient, and that they had some good memories together right up until the last moment.”
 
“We have decided to give this version of palliative care a new name: Compassionate Care.” Says Dr. Jinda. “We get to know all of the patient’s family members and hold meetings with them regularly. We give them space to air their views concerning the treatment and wellbeing of the patient to us and each other, which is a very delicate matter.”
 
Some families don’t express their feeling to each other. Some cultures, such as Chinese, believe that speaking of death is a bad thing. Some believe that the true extent of the patient’s condition should be kept a secret, even to the patient themselves. Sometimes it is the patient who wants to keep it a secret from their relatives. These are some of the challenges that Dr. Jinda faces.
 
“Once we have stabilized the patient’s emotional condition, we are then able to explore various kinds of emotional care for each individual family member. Whether it be art therapy, music therapy, breathing therapy, or total relaxation, all of these are ways in which we can kept the negativity at bay for all concerned. It helps them to find the positive in what is happening.”
 

Dealing with convergent factors

It is clear that palliative care is a great way to smooth out the more turbulent aspects of cancer treatment. In palliative care, the patient has a real say in what happens, and that’s where it really shines. It can incorporate individual life plans and goals as well as religious and cultural beliefs, for which members of the clergy for each respective belief may be invited to speak to the patients and their families as required.
 
Lastly, it must be acknowledged that deep cooperation and collaboration among many different parties is necessary for a beautiful ending to this chapter of their lives. Trust must exist between the families and all of the hospital’s medical staff for everybody to be their authentic selves in this period, which is one of the patient’s most crucial needs.
 
“Far from being a bad omen, or a curse, speaking openly about the final days allows everyone to make the best plans possible. Having the time and space discuss delicate matters and come to mutual understandings is far better than an emotional whirlwind at the last minute. The more prepared you are the better, so this process should ideally begin well before the terminal stages. We sincerely wish to empower the patients to live their very best lives in the way that they wish to, even when it seems like there is not much under their control as the end approaches. Together, we can make this a beautiful ending” Dr. Jinda says with a smile.
 

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