Global Health Asia-Pacific July 2020 July 2020 | Page 75

There was also serious concern that the cervical spine (meaning the bones surrounding the spinal cord at the back of the neck) had been badly affected by the cancer. The neurosurgeon who consulted on the patient explained that there was a high risk that the spinal cord would eventually be affected and that he could become paraplegic (paralysed in both legs). As the disease was too advanced, surgery was not advisable as the spine was unstable. We discussed the option of doing nothing, meaning to go back either to China or the U.S. However, Mr Li was not prepared to give up and wanted treatment. Left with little choice, I came up with a cocktail of chemotherapy drugs combined with immunotherapy. I explained that this was a rather desperate attempt to control the disease. After two months of treatment, the �ET-CT scan in �une 2014 miraculously showed that the cancer had responded in all the sites. As the treatment had to be administered once every two weeks, Mr Li accompanied by his faithful wife, had to fly to �ingapore fortnightly. In between the treatment visits, he would sometimes stay in Singapore, or travel back and forth to Beijing, Hong Kong, or the U.S. On the 17 March 2015, I received a frantic call from his friend that he was again coughing up blood. I advised her to quickly call an ambulance to bring him either to see me or the nearest hospital. Not long after, I was on the line with the ambulance nurse, who informed me that despite their best efforts at resuscitation, Mr Li had passed away. I had just seen the patient four days earlier when he came for his fortnightly treatment. He was in reasonably good health. He was looking forward to his son’s visit to Singapore. So it was a shock to me that he would pass away so suddenly. I imagined that his family must have been even more distraught and probably angry with me. �ess than a week after the event, my staff informed me that his wife was outside in the waiting area and had requested to see me. I braced myself and muttered a silent prayer. When she came into the room, she gushed words of deep appreciation for all that I had done for her husband. She related, in very eloquent Chinese, how much her husband appreciated the care that I had given him. 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. �he went on to describe the final event. They had been shopping that morning followed by lunch with their son. After coming home from lunch, he suddenly started coughing up massive amounts of blood. Her son, who is a doctor, shooed her out of the room as he tried his best to resuscitate his father. Despite his best efforts and the assistance of the ambulance team, Mr Li passed away. She expressed that the last one year meant a lot to them. While the final event was traumatic for her, she was glad that the end was swift and painless for him. She went on to explain her plans to bring his ashes back to the U.S. and then eventually to Beijing. After one final hug, she left. I had to compose myself for a short while before I could carry on seeing patients. The eventual death of cancer patients is largely expected as up to 70 percent of them present with stage four disease. However, while the timing of the final event is sometimes anticipated, at other times it’s unexpected. The reaction of the family to a patient’s death is equally unpredictable. Some are appreciative of the fact that we have done our best. Others feel that we have not done enough. Oncologists have to deal with death all the time. With each passing, we give a little of ourselves. n Dr Ang Peng Tiam is the medical director of the Parkway Cancer Centre in Singapore. He is a council member of the Singapore Cancer Society and the past president of the Singapore Society of Oncology. He held the concurrent post of Director of the Oncology Centre and Clinical Associate Professor at the Faculty of Medicine of the National University of Singapore. I braced myself and muttered a silent prayer. When she came into the room, she gushed words of deep appreciation for all that I had done for her husband GlobalHealthAndTravel.com JULY 2020 73