Happiness and Palliative Care
Ms. R. Vijayalakshmi, Chennai
In my personal opinion, “Achievements, goals, fame or fortune may not provide one with true happiness. Lasting happiness is wholly and soley provided only in our mind and heart”. Let me expand on this a bit more with the below article.
I met Mr. Raghupathy (name changed), a wonderful and bubbly 70 year old gentleman who was diagnosed with Ca stomach, 4th stage, during one of our home visits. During our very first meeting itself he shared with our team, several of his energy packed life stories. He began by introducing himself, his professional journey thus far and his thoughts about our visit to him. As we began chatting, we realised that he was fully aware of his prognosis. As you would have imagined by now, Mr Raghupathy was an extrovert who enjoyed his company, loved and relished his food, would often get lost in reading books and firmly believed that had lived his life to the fullest.
We learnt that Mr Raghupathy had decided to not undergo chemotherapy as he did not want to put himself through the treatment related suffering. His family was also supportive and stood by his decision. Mr. Raghupathy even told us that he was ready to pass on and have his peaceful end.
However, as time progressed, Mr Raghupathy began to experience pain. Now filled with guilt and confusion, he began to ruminate about his decision, and was now contemplating if he had made the right choice of not undergoing Chemotherapy. There were times when he felt that maybe if he had undergone chemotherapy, he would have had less pain. You see, Mr Raghupathy wasn’t expecting to be in so much pain and to get so weak, physically. This physical pain had taken a huge toll on his otherwise strong mental health.
It was then that we realised that despite being aware of his prognosis, what Mr. Raghupathy had unfortunately assumed was that he would die suddenly and pain free, as he had not understood completely, the process of suffering associated with advanced cancer. We then explained to him in detail, what his body was going through and assured him that our team would be there for him and his family, and that we would help manage his physical symptoms such as vomiting, constipation, weakness, fatigue, pain, etc. This understanding and assurance provided by our team, significantly reduced his psychological and emotional distress.
During our second home visit, which was approximately 10 days since this conversation, we reassessed his symptoms and provided him with the relevant time appropriate guidance and continued to manage his pain along with his other symptoms.
When we went for our third home visit, we noticed that the ever smiling and bubbly Mr Raghupathy was not seated in his usual chair in the hall to welcome us, but had now been moved to his bed. Despite being bedridden, his face lit up when he saw us. As we began chatting, he told us that his expectation was finally being met – a peaceful end-of-life without pain and suffering. He shared that he was happy to see us and then continued to share with us his life stories for the next one hour. We noticed that the stories by the third visit had gotten more personal as he treated us as one of his own. The stories now revolved around his love story with his wife, his relationships and the various lessons he learnt over time. With his wife and us by his side, he even telephoned a few of his relatives and close friends to say his final good bye. He wished them well and blessed them.
As we were preparing to leave I asked him, “How are you feeling now?”. He paused, reflected and then told me “I am now content”. My team and I were now convinced that this wonderful human being, Mr Raghupathy, now had gained complete insight into his death, and was now satisfied as he was getting what he always wanted, a peaceful end-of-life without pain and suffering!
A few days later, we learnt that Mr Raghupathy had passed on, without pain and in contentment.
You see, support from the palliative care team helps patients to achieve quality of life, as their symptoms are well managed along with guidance and access to relevant information during the last stage of their journey. I can now say that effective symptom alleviation, appropriate family support, the acceptance of death and the resulting contentment gave Mr Raghupathy, happiness at the end of his life.
I leave you with this anecdote, “Nothing beautiful comes without suffering and that the only place where change can begin is with acceptance”.