Distress to de-stress: A journey

Distress to de-stress: A journey

– Dr. Ravi Kiran Pothamsetty, Madurai

Mrs. Shanti (name changed for confidentiality), a 66-year-old female and a post-treated case of endometrial and ovarian carcinoma recently visited the Medical Oncology OPD with her daughter-in-law, exhibiting despair and mood turbulence. She was referred to the Palliative Care team. We introduced her our Palliative Care team, and explained the primary physician’s referral intent. Initially sceptical, she slowly eased into the conversation as we discussed her daily life, adopting a support group approach rather than a typical OPD session.

Initially, she was in despair, but gradually, she started to engage with us, sobbing and slowly unfolding her story. “Why can’t you give me something to end this suffering, for everyone’s sake?” she asked us. She confessed that she had wanted to ask the primary physician this but couldn’t. This outburst is common in the later stages of the cancer journey, where the patient’s psychological well-being is constantly turbulent, conflicting between rational and emotional minds.

With the assistance of the psychologist, the conversation has been navigated to her personal life, regarding her family structure, family dynamics and inter/intra personal relationships. This exploration led us to the realization that her social and spiritual pain had a far greater effect on her overall wellbeing than her physical suffering.

She said that she has issues with her son. Her son struggles financially. She never gets quality time with her son which made her thinking critical. She wants her son to be cordial and gentle. She couldn’t share this with the primary physician due  to her inhibitions and thought  it was irrelevant.

We have given her time and space to vent out the emotions without interruptions. We involved the caregiver to share her insights also, whereupon Shanti spoke at length about her deceased spouse. We intervened, counselled and utilized this opportunity to modulate her thought process. We also suggested breathing exercises and distractions which she can do at ease. We explored her hobbies, interest in music and spiritual orientation, and encouraged the caregiver to assist Mrs Shanti whenever needed. Indeed, it took time and efforts to materialize the session. During this particular emotional session, Mrs Shanti was overwhelmed with gratitude for the support she received. She hugged our psychologist whispering words of compassion and  resilience.  The session transformed from melancholic to rapturous, a stark contrast to its clinical tone.

“I smiled today,” the patient said softly, her voice fragile yet filled with a newfound strength. “It’s been so long since I have felt this way.” The primary informal caregiver (daughter- in- law) was puzzled that, despite being well cared for, her mother-in-law remained distressed.  The primary caregiver was also surprised that her mother-in-law has not disclosed these issues at home, and this session has given her mother-in-law the opportunity to unravel the suffering. We encouraged her to contact us through tele-health or visit the Palliative care unit whenever needed and suggested to following up with the team.

The purpose of sharing this patient-healer interaction is to demonstrate the crucial role of Palliative Care and Oncology. These two disciplines are inseparable and essential components of comprehensive care, serving as the fourth pillar of the precision care spectrum.  In Tier II cities, where resources and attrition pose practical challenges, the provision of holistic care becomes arduous. An action plan is mandated to streamline patient care across all dimensions on regular basis.

.Palliare ↔ Palliative = ‘Protection’

Protection is applicable to wellbeing of all living beings regardless of gender, community and chronic health sufferings.

I dedicate this article to the “World Kindness Day” celebrated annually on November 13^th worldwide. The goal of this international celebration is simple: “make kindness the standard instead of the exception”.