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|Year : 2007 | Volume
| Issue : 1 | Page : 15-16
Dealing with death: Perspectives of two students on palliative care
Omprakash Damodaran1, Conan Chan2
1 Liverpool Hospital, Sydney, Australia
2 Royal North shore Hospital, Sydney, Australia
Liverpool Hospital, Sydney
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Damodaran O, Chan C. Dealing with death: Perspectives of two students on palliative care. Indian J Palliat Care 2007;13:15-6
| » Introduction|| |
The following writing is a reflection of our experience with a dying patient during a 3 rd year palliative care attachment at the University of Newcastle, Australia. This rotation involved following a palliative care patient and his family's journey over a course of 3 months.
| » Patient's Story|| |
Paul was a 67-year-old married man. He lived with his wife and visually impaired daughter in Newcastle, Australia. He enjoyed good social support from his friends and family and was fond of walking and going to church.
Paul presented in December 2002 with symptoms of lassitude, fatigue, weight loss and constipation. End-stage metastatic pancreatic cancer was diagnosed following various investigations. Paul was referred for palliative care consultation in late January. Towards March, the patient deteriorated, developing severe ascites and jaundice. By the beginning of April, Paul was placed on sub-cutaneous infusion of morphine and midazolam, as he was unable to tolerate oral medications. However, Paul died 3 months after his initial diagnosis.
| » Our Story|| |
To prepare for the attachment, we observed a series of lectures, including videos that depicted the terminal phase of a patient's illness. However, the material could not completely dissolve our apprehensions about meeting Paul. With limited experience we had from talking to patients with terminal illness, this was an entirely new experience, which initiated considerations of our own mortality.
We doubted the educational value of the task and felt it was just another hurdle within the medical degree. However, as the attachment progressed, we began to understand its importance. Although in illness, Paul was an invaluable teacher. He invited us into his life and allowed us to learn through his experience. He became pertinent in shaping the way in which we approached the issue of death.
Mann T.  once said, "A man's dying is more the survivors' affair than his own". This became evident to us through our interactions with Paul. Initially, we were only comfortable with discussing medical issues. We felt that discussions on philosophical, spiritual and social matters were likely to be intrusive for the patient.
Nevertheless, we were able to unmask Paul's concerns about what would become of his family and business after his death. Isaac Asimov  described this transition period that concerned Paul as 'troublesome'. Paul was concerned for his partially disabled daughter's welfare and his wife's ability to manage their business. He spent much of his limited time sorting his business affairs and hosting reunions with his family and friends.
On numerous occasions, Paul and his wife had expressed concern about the large numbers of visitors to their house. Despite their reassurances, we felt guilty at times for imposing on the family. Paul reassured us, but he was unaware how beneficial he was to our education. Throughout the 6-week journey with Paul, we were able to witness his deterioration and understand some of the spiritual and emotional issues surrounding his death.
Initial discussions on psycho-spiritual issues made him teary. However, Paul denied the possibility of depression. These issues became important in forging a stronger bond with Paul and gave us greater insight into his thoughts. As our attachment progressed, Paul felt much more comfortable in discussing religion and concepts of afterlife. A palliative care nurse who had visited Paul regularly discussed psycho-spiritual topics with him and may have, according to Pierre Corneille,  "calmed one's grief by recounting it".
Paul was a firm believer in the 'quality rather than quantity' of life. As such, endoscopic retrograde cholangiopancreatography (ERCP) stenting to relieve his biliary obstruction and prolong his life did not interest him.
Paul's wife, Jane, supported his decisions. Despite the stressful situation, she appeared quite stoic throughout our meetings. However, since the time we spent with the couple was short, it was difficult for us to gauge the extent of emotional burden.
In our final visit before Paul's death, Jane mentioned that palliative care services were helpful in easing her anxieties about her husband's deterioration. Paul added that he was grateful for the services we offered during this difficult stage in his life.
Paul had been a great teacher. He taught us the part of medicine that textbooks or other doctors cannot. This experience made us confront our own mortality and taught us methods to comfort dying patients. We genuinely feel that Paul's death made a real impression on our lives and future practice of medicine. The Austrian author Hermann Broch  summated it beautifully - "No one's death comes to pass without making some impression and those close to the deceased inherit part of the liberated soul and become richer in their humaneness".
| » Acknowledgement|| |
We acknowledge the opportunity for learning provided to us by the Hunter Palliative care service, Newcastle, Australia.
| » References|| |
|1.||Mann T. The magic mountain (Der Zauberberg). Knopf: New York; 1953. |
|2.||Green J. The Pan Dictionary of Contemporary Quotations. Pan Books: London; 1989. |
|3.||Bartlett J. Familiar Quotations. Boston Little Brown and Company: Boston; 1992. |
|4.||Broch H. The Death of Virgil. Penguin Press: New York; 2000. |