Tag Archives: Terminal Care

Letting Go, the HARDEST, Decision

On difficult decisions of terminal care, because it’s hard, and we will all have to face something like this at one time in our lives or another, maybe with our own loved ones, maybe, when we get older ourselves…translated…

In This Process of “Letting Go”, it’s Next to Impossible for Those Who Aren’t in the Process to Know What Goodbye is Like………

The idiom of “long-term sickness brings NO good son”.  There’d been the news reports on this matter, and, most of the people after hearing, they’d only felt chilled, or, that it was only, matter-of-fact.  But in the medical realm, we watched the younger generations shouldered up the responsibilities of caring for their elders until the end; and yet, with the worsening of the elders’ conditions, the caretakers usually felt burned out, and started thinking of “letting go”.  And, in this process of letting go, the heavy heart of the love for ones’ next-of-kin, and the sense of responsibilities, nobody on the outside can understand.

Insomnia is the Norm

Mr. Chen is seventy-six, eight years ago, he’d started dialysis, because he was the C.E.O. of a company, even as on Wednesdays he was due for the procedures, he’d still gone to his office to make the rounds first, visiting his old clients regularly.

At the start of last year, he’d started feeling the lower back pains, at first, he thought it was sciatica, after he had an MRI, it was the granulomatous spondylitis, and even as the surgery helped alleviate the symptoms, but, because he was bedridden too long after the surgery, his an elder, and a dialysis patient too, losing his muscle mass had greatly reduced his physical activity levels, and in the end, he’d needed his family to help him get through the days of his normal living.

illustration from UDN.com

This authority in business, a C.E.O., suddenly became someone who can’t control his own body, a patient, Mr. Chen’s moods altered as well.  But, as his families considered placing him into a nursing home facility, Mrs. Chen decided to shoulder all of his care on other own.

As she’d come in to get her insomnia treated, I’d asked her, if her body could take it?  She’d said, she’s older, and as her husband hollered, she’d had to go to him quickly, surely, there was, enormous stress on her, in the past six months, she’d started feeling the strains.  But, thinking about “letting go” of her husband whom she’d stayed close to for half a century’s time, she couldn’t, accept that……………

Her First Words Were “I Want to Go Home”

Another elderly woman, Grandma Shih, who had kidney problems due to her diabetes who is a regular at my clinic, I’d been her physician for more than decades, I’d gotten to know her families well, knew that her offspring took care of her living needs daily, so her kidney function was quite stabilized.  Once I’d thought, that she will never need dialysis, but, her heart failed, and at the age of ninety-three, she’d entered the line of dialysis.

There would be the many situations in the elderly population after the dialysis especially, and, a more complex set of complications compared to the younger generations, for instance, infections from bacteria or virus, or, hemorrhages, it’d made her come in and out of the hospital many a time, she’d become, weakened, in the end, she’d relied on the feeding tubes, and I saw her son, with his eyes red, as he’d, fed the formula into his own mother’s feeding tubes, and I’d felt really bad, and, can’t believe, that Grandma Shih would need this sort of an end-of-life care for her.

As she choked on her own vomit that final time, Grandma Shih lost her vitals on the way to the hospitals, because the conditions were critical then, we’d immediately intubated her, although afterwards, the families held different opinions on intubation, but, at the moment, it was emergent.  Luckily, the elderly pulled through, and started breathing on her own, it’s just that as she was discharged from the hospitals, she’d become, bedridden, and her days and nights were, flipped, causing too much strain on her loved ones, as well as the nurse’s aide too.

Because of necessity, they’d found a facility that can perform the dialysis for her, placed the elderly woman in the home, so she could get the care she’d needed.  At first, as the son went to visit, Grandma Shih remained silent, and her eyes couldn’t focus; but after a week, she’d recalled her son’s name, and started stating, “I want to go home”.  And, this made her son started blaming himself for deciding to place his own mother in a nursing home facility.

In the final passage of her life, Grandma Shih continued staying in the nursing home facility.  Six months after she’d passed, her son told me, “Sometimes I’d regretted it, not known, if I’d done right by her or not”, even if they couldn’t watch over Grandma Shih around the clock—that seemingly easier option became, the road block he tried to cross over his whole life.

Those with the long-term illnesses, are the ones suffering, and, the primary caretakers around them are, too strained, it is a difficult choice, letting go, or not; if you’d chosen to not let go, you’d be straining yourself, and, you have to feel the pains and sufferings of the ones you love dearly; but as you’d selected to let go, you are filled with the unwillingness of letting them die, and this may cause you to regret it for the rest of your lives.

And so, there you have it, this is a difficult decision, that we will all face someday, maybe it’s with our own parents, or, when we get older ourselves, and, there’s still no right or wrong on this, and, that’s just, how life goes, sometimes, we’re, just forced to make these hard decisions for the ones we love dearly, because we don’t want them to suffer anymore, and sometimes, we choose to keep them alive, because we aren’t, ready, to say goodbye yet, and, by doing that, we’re, prolonging their, suffering.

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The Tragedies that Were Caused by Misunderstandings in Terminal Care

On the medical fronts, translated…

From the horrible experience of a 24-year-old young woman diagnosed with liver cancer:

Even though, Pearl had been inoculated with hepatitis B shots as she was younger, but because the antibodies were gone, she’d still contracted hepatitis B.  She didn’t know she needed to go for an abdominal ultrasound every six months, along with the importance of getting her alpha FP fetal proteins checked, and when she’d found out she had liver cancer, the tumor was already nine centimeters, too big to be removed.

The family decided to not tell her, just told her, that it was a benign tumor.  Pearl believed the words of her family and friends, and only took to natural therapies and alternative therapies.  But the cancer cells spread too quickly, in a short four months time, the patient was already terminal, and she’d felt a ton of abdominal pains.

Pearl’s mother works for a church, the pastor’s wife had positive experiences with terminal care, she’d worked hard, to convince the parents to send the daughter into the terminal treatment ward, to allow her to be well taken care of in the body, the mind, the soul and the heart.  Pearl’s parents went for a tour in the terminal ward, felt satisfied, and hoped to place their daughter there; but unfortunately, Pearl’s sister refused, said, “as long as my sister is alive, I will NEVER allow her to be placed in the terminal wards!”

And so, Pearl stayed in the regular ward, but because they couldn’t manage the pains well, she’d cried out in pain every single day, and wanted to die.  And she’d lived on for three more weeks afterwards, and, the girl passed away, in her own screams, as the tumors in her liver burst open.

The Common Misconception that the Public Has for Terminal Care

Most of the knowledge that the Taiwanese people have of terminal care is negative, but in reality, terminal care is already in abundance in the more advanced countries, and the WHO spoke positively of it, that it’s a modern day method, to making the quality of life better for the terminally ill.

Terminal care is not the same as waiting for death, nor is it giving up hope, or giving up on the aggressive treatments!  After all, there IS no such terms as “aggressive treatments” or “passive treatments”.  Related treatment measures include: healing, controlling the illnesses, supportive treatments, less invasive therapies, along with terminal care, which option one chooses, should be reliant on the conditions, and not on which doctor’s methods the patients choose to follow, or which ward they’re staying in.

For instance, a person with multiple organ failures, because of her/his vital organs had failed, and couldn’t trade in for a brand new set, even though, the person is in the ICU, at this time, the only thing that CAN be done is the supportive and the alleviating types of therapies.

And so, this, is why there’s a need for this terminal care program, because we don’t want our loved ones, or ourselves, to suffer to the very end, do we?  Nope, and yet, because there’s barely ANY education in the matter, that, is why the subject is not being discussed enough at all.

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