Global Health Asia-Pacific July 2020 July 2020 | Page 74

Column
Doctors also have to find closure after death
Dr Ang Peng Tiam shares the difficulties of facing patient demise
He had told
her that I was
more than a
doctor to him.
He considered
me his friend
and brother.
As she spoke,
she wept
openly as my
eyes teared
One of the hardest tasks for a cancer specialist
to deal with is to face the family when a patient
dies. No matter how much counselling and
discussion has gone into preparing them for the
inevitable, it’s often difficult to predict how the family
will react to the actual demise of their loved one.
Mr Li was a 51-year-old Chinese researcher who
was born in Beijing but had lived in the U.S. for many
years. He was first diagnosed with stage two kidney
cancer for which surgery was carried out in March
2007.
Within two years, his cancer recurred. Initially, it
affected the lungs but eventually spread to the bones.
He was extensively treated in the U.S. with the whole
range of targeted drugs.
Sorafenib (Nexavar ® ) and sunitinib (Sutent ® ), two
established medicines in the treatment of metastatic
kidney cancer, had already been used. While there
was some initial improvement, the disease eventually
progressed as the cancer cells developed resistance
to the treatment.
Radiotherapy had also been deployed to treat the
bone metastases.
I’m not sure why he decided to come to Singapore
to see me, but I first met him on 31 March 2014. At that
stage, he was already in a bad state as he had severe
pain from metastases to the bones.
He also complained of coughing up blood caused
by lung metastases and a low platelet count. When
there’s tissue injury in our body, platelets are essential
to help stop the bleeding.
The whole body PET-CT and an MRI of the spine
showed that his cancer was widespread, involving the
spine, lungs, lymph nodes, and abdomen.
72 JULY 2020 GlobalHealthAndTravel.com