Family Care

In certain situation when you are managing a terminally ill patient, you are actually treating the family and relative compare to treating the patient him/herself.

A term DIL/DNR are used in hospital setting when you have decided that medical or surgical therapy will bring no benefit and may cause more harm to the patient. Or it may not bring benefit and only used to prolong patient life of suffering with pain. Euthanasia is not a common practice in most part of the world. I also did not agree personally to this method of painless killing of patient even sometimes dying is much better outcome for a patient compare to his/her suffering throughout the last day of their life. No. I am opposing Euthanasia. 

So DIL/DNR bring much better definition in our practice in medical field. The term should reflect the quality of care that is given to that patient. Labelling DIL/DNR bring our attention that the patient need to be kept comfortable till the end of his or her time. 

Most DIL/DNR patient were cancer patient. Stage 4 cancer which no treatment up to date prove to cure the disease. It is a very unfortunate disease that will cause you to slowly lost your grip in life. You may die in peace but most of them die in pain. 

Terminally ill patient can be conscious and alert and lived their life to the fullest until the time has come. Some of the patient will not have the ability to even talk or ask for comfort. This kind of patient will rely solely on the people around them to bring them comfort and to hold their hands till their time has come. 

As a medical officer, our care is to give the most appropriate pain killer or whatever symptomatic treatment that we could provide at best. The nurses will keep on observing, measuring urine, checking blood pressure and making sure the medication served as order by doctor. 

I want to highlight the most important role in managing this kind of patient is not the doctor, not the nurse, not the specialist in tertiary centre, not the director of hospital, but the family themselves. 

For me a family of such patient need to take the responsibility same as the doctor and the nurse in the hospital. They should understand the disease progress, help turning the patient, keep patient clean and give moral support.

I do not know why a family of terminal ill patient usually the most difficult one to handle. They tend to scold the nurse for not changing the diaper, or late in draining the urine bag. They always scold and show disrespect to the doctor if the doctor did not attend the patient as immediately as possible just because patient complain of pain which will always be there. I am not talking about those family who over concern or maybe afraid if the patient complain of pain, but to those who stand like a boss and ask you to do stuff for them. I am talking about those relative who give order to doctor. Do this, do that....for what?

In the end, what the patient need is to be as comfortable as he could. To be with his or her family as much as they can. Not the doctors who bring them bad news, not to the nurse, not to the pharmacist not to the attendance. They need their family to be with them and to take care of them as much as possible.

Yet most family will request all of this patient to be in the hospital and once in a while they will come during visiting hours and order this and that, then leave at the end of the visiting hours, leaving the patient alone, hoping that he or she will die when the family are around.