Building the best endgame of your life - Celebrating life, creating memories End-of-life journey with a community care team - Singapore Hospice ...
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DECEMBER 2020 – FEBRUARY 2021 • MCI (P) 003/10/2020
Celebrating life,
creating memories
End-of-life journey with
a community care team
Building the best
endgame of your life
PLUS
HeARTS in
ACTion
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THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
CHIEF EXECUTIVE’S NOTE
Members’ Contacts Contents
Alexandra Hospital
378 Alexandra Road, S(159964)
T: 6472 2000 F: 6379 4339
www.ah.com.sg
Ng Teng Fong General Hospital
1 Jurong East Street 21, S(609606)
T: 6716 2000 F: 6716 5500
www.ntfgh.com.sg
“
If you are working on something that you really care about,
you don’t have to be pushed. The vision pulls you.”
AH_Enquiries@nuhs.edu.sg enquiries@juronghealth.com.sg
Assisi Hospice The Palliative Care Centre for Excellence STEVE JOBS
832 Thomson Road, S(574627) in Research and Education (PalC)
T: 6832 2650 F: 6253 5312 PalC c/o Dover Park Hospice
www.assisihospice.org.sg 10 Jalan Tan Tock Seng, S(308436)
assisi@assisihospice.org.sg T: 6500 7269 e often perceive that we are in 100% Hence, your openness to accept this change by
6
www.palc.org.sg
Buddhist Compassion Relief
Tzu Chi Foundation (Singapore)
9 Elias Road, S(519937)
T: 6582 9958 F: 6582 9952
enquiries@palc.org.sg
Sengkang General Hospital
110 Sengkang East Way, S(544886)
W control as the author of our own life.
Many of us are living day-to-day
with hopes and dreams; trying to
making your final wishes known and recorded as an
objective legal document will enable your loved ones
to carry out your plans.
www.tzuchi.org.sg/en T: 6930 6000 figure out what we want from life. As we enter This process could involve discussing all the
www.skh.com.sg into the “Thought Life Cycle”, how many of us conditions surrounding the subject of preference
Changi General Hospital have clearly defined our preferred endgame? before one dies, as opposed to during or after. Having
2 Simei Street 3, S(529889) Singapore Cancer Society 2 Members’ Contacts
T: 6788 8833 F: 6788 0933 15 Enggor Street, #04-01, It will not be distressing if our palliative care these discussions upfront can certainly make the
www.cgh.com.sg Realty Centre, S(079716) plans are made known as one reaches the end of process easier.
T: 1800 727 3333 3 Chief Executive’s Note life. In fact, knowing what to expect can minimise It is therefore important to communicate your
Dover Park Hospice www.singaporecancersociety.org.sg
10 Jalan Tan Tock Seng, S(308436) hospice@singaporecancersociety.org.sg guessing and certainly enable all involved to Thought g Desire g Belief g Plan g Wish to your ideal
T: 6500 7272 F: 6258 9007 4 Top 5 end-of-life support one another with dignity. endgame. Solidifying this as an end-of-life plan will
www.doverpark.org.sg Singapore General Hospital Therefore, it is critical to acknowledge and help ease the minds of everyone involved and have a
info@doverpark.org.sg Department of Internal Medicine, concerns
The Academia, Level 4, accept that the palliative care plans will allow the positive impact on your life.
HCA Hospice Care 20 College Road, S(169856) terminally ill to avoid unnecessary pain, physical, Take these quick steps to navigate your thoughts
705 Serangoon Road, Block A #03-01 T: 6222 3322 6 Celebrating life, psychological and spiritual distress and allow as there will come a time when either death can no
@Kwong Wai Shiu Hospital, S(328127) www.sgh.com.sg
T: 6251 2561 F: 6291 1076 sghfeedback@sgh.com.sg
creating memories them to spend quality time with loved ones in a longer be prevented or the burden of treatments
www.hca.org.sg place of their choice. outweighs the benefits for that individual.
contactus@hcahospicecare.org.sg SingHealth Community Hospitals
(Bright Vision Hospital, 8 The final send-off
Khoo Teck Puat Hospital Outram Community Hospital,
90 Yishun Central, S(768828) Sengkang Community Hospital)
T: 6555 8000 F: 6602 3700 10 Hospital Boulevard, S(168582) 10 End-of-life journey with Step One Step Two Step Three Step Four Step Five
www.ktph.com.sg T: 6970 3000 a community care team RECOGNISE COMMUNICATE INVOLVE SUPPORT IMPLEMENT
www.singhealth.com.sg/SCH
KK Women’s and
Children’s Hospital St. Andrew’s Community Hospital 12 HeARTS in ACTion: • that it is important • with your loved • those important • should be expressed • the individual
100 Bukit Timah Road, S(229899) 8 Simei Street 3, S(529895) to communicate ones, allowing to you in from your loved care plan
T: 6225 5554 F: 6293 7933 T: 6586 1000 a virtual celebration
www.kkh.com.sg www.sach.org.sg clearly, enable them to know decisions about ones and the as agreed,
general@sach.org.sg decisions to your thoughts on treatment and multidisciplinary coordinated and
Lien Centre for Palliative Care 16 Regrets, reconciliation, be made and these important care to the extent team. delivered with
Duke-NUS St Joseph’s Home actions taken in life topics like that you wish. • includes compassion.
Medical School Singapore 36 Jurong West St 24, S(648141) resolution
8 College Road T: 6268 0482 F: 6268 4787
accordance with relationships, understanding the
Level 4, S(169857) www.stjh.org.sg the person’s needs finances, personal needs of your family
T: 6601 2034 / 6601 7424 [Education] general@stjh.org.sg 18 Walking the last journey and wishes. beliefs, care and loved ones.
T: 6601 5113 [Research] • that these choices preferences, • can be extending
www.duke-nus.edu.sg/lcpc St Luke’s Hospital can be reviewed death, re- additional resources
2 Bukit Batok Street 11, S(659674) 20 Love and devotion
Metta Hospice Care regularly and addressing regrets to meet your
32 Simei Street 1,
T: 6563 2281 F: 6561 8205
www.slh.org.sg
magnified decisions revised and reconciliation. palliative care needs
Metta Building, S(529950) referral@stluke.org.sg accordingly. as much as possible.
T: 6580 4695 F: 6787 7542
www.metta.org.sg Tan Tock Seng Hospital
22 Help is just around
hhospice@metta.org.sg 11 Jalan Tan Tock Seng, S(308433) the corner
T: 6256 6011
MWS Home Care & Home Hospice www.ttsh.com.sg Therefore:
2 Kallang Avenue, 24 Celebrate SHC’s 25 years
CT Hub #08-14, S(339407) Tsao Foundation
“
T: 6435 0270 F: 6435 0274 298 Tiong Bahru Road of impacting lives! /
www.mws.sg/centre-location/ Central Plaza, #15-01/06, S(168730) Events calendar
mws-home-care-home-hospice T: 6593 9500 F: 6593 9505
MWShh@mws.sg www.tsaofoundation.org
National Cancer
info@tsaofoundation.org Setting goals is the first step in
Centre Singapore Woodlands Health Campus
11 Hospital Drive, S(169610)
T: 6436 8000 F: 6225 6283
9 Maxwell Road,
MND Complex Annex A,
turning the invisible into the visible.” Ms Evelyn Leong
Chief Executive
www.nccs.com.sg #03-01A, S(069112)
T: 6681 5999 TONY ROBBINS Singapore Hospice Council
www.whc.sg
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THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
TOP OF MIND
5
3
Top end-of-life WORRIES ABOUT FAMILY
AND LOVED ONES
as their best companions may
also be very worried about
The weight from the sense of leaving them behind.
concerns responsibility towards those
entrusted to our care impacts
us especially when we might
no longer be able to fulfil our
Case study:
Madam C’s life was complete
because she was living life with found someone who was willing
Assisi Hospice’s Psychosocial Support Services team shares the most commitments. A dying parent her three precious cats. Amidst to take in all three with the
with young children may need coping with many transitions assurance that the cats would
common worries of persons at their end-of-life, gathered from
to deal with profound feelings in life, she had an unwavering be well loved. Madam C bade
their interactions with and learning from our patients. of loss, guilt and anxiety. Dying desire to find trusted cat lovers her final goodbyes to them and
as adult children to elderly and who would take over the care of felt a heavy weight lifted off her
frail parents may involve intense her three precious cats after she shoulders; she expressed that she
feelings of helplessness and departs this life. She took care not was ready to embrace the final
regret. Someone living with pets to separate the trio and eventually days of her life.
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Armed with only a pair of shorts
and t-shirt, and a desire to regain
his dignity, he checked into
Assisi Inpatient Hospice Care. His
longing for dignity on his own TO ENJOY FREEDOM AND TO ACHIEVE A SENSE OF
terms soon manifested in the form INDEPENDENCE FOR AS LONG COMPLETION IN LIFE
of anger and hostility towards the AS POSSIBLE Humans seek to achieve a sense of completion
Care Team when his needs could It is human nature to seek control over the in life through meaningful connections with
1 not be met. With much support
and mutual understanding, he
eventually allowed the Care
circumstances of one’s life. However, we have
no control over the inevitability of death. This
demoralises many people. At the end of life,
others as well as with oneself. We bear witness
to many persons narrating their life stories of
love, regret, and more. While many may seek
Team into his personal space and many seek to preserve their remaining sense a more perfect life, completion is what really
TO PRESERVE DIGNITY integrity. Individuals have varied taught them the value of dignity of independence by fiercely protecting what matters in the face of one’s mortality. Even in
The word dignity originates from and unique appreciation of what in his life and what they could is important to them and attempt to exert scenarios where a person has no loved ones left,
two Latin words — dignitus (merit) dignity means to them. do to support him the right way. some form of control through words and there is a need to make meaning about how life
and dignus (worth). The concept With much effort on the part of behaviour. It is important to recognise these has unfolded and to articulate the purpose and
of dignity is multidimensional Case study: the team, he moved into a rental attempts and render the needed support for the meaning of the life that has been lived.
and complex. When dying, each Mr A told us that his landlord flat and had a place to call home individual to maintain some control and
person is confronted with different threw away his most prized for a few months where he could independence; sometimes this could Case study:
challenges that threaten his or her possession during his prolonged live independently. He has found just be listening to them talk about Mr E sought the help of the Assisi Hospice’s
physical, emotional, and spiritual hospitalisation — his dignity. his dignity. their desires and hopes. Psychosocial Support Services (PSS) team to
reconnect with his estranged wife and children.
Case study: His family was unwilling to visit him, even though
WORDS ASSISI HOSPICE MS PEH CHENG WAN PHOTO ASSISI HOSPICE
Mr D has lived with an elderly he was dying, due to the past trauma inflicted by
2
and frail flatmate in their humble Mr E which continued to have a profound effect
two-room HDB rental flat for years. on them. The team supported Mr E by finding
TO ENSURE PHYSICAL have to suffer in pain or choke to He was admitted into Assisi Inpatient Hospice closure and reconciliation within himself. He felt
COMFORT TILL death. She did not fear death as Care due to the lack of a caregiver as he lived remorseful for being a bad husband and father.
THE VERY END dying process. Maintaining she looked forward to returning to the final days of his life. Mr D repeatedly asked He found meaning in understanding that he
American film director and actor, physical comfort also helps one her heavenly home, but she feared to return home as he really missed the sound of would bring them less pain if he didn’t force them
Woody Allen, famously quipped, to cope better with emotional the pain and suffering. She would his standing fan as he rested in bed, the familiar towards a formality that was important for him.
“I’m not afraid of death; I just don’t and spiritual needs at end-of-life. rather be less awake than awake aroma of coffee from the corner of the street, and He penned a letter to his family, expressing his
want to be there when it happens.” with pain and discomfort. After the camaraderie with friends and neighbours apology and gratitude towards them for being in
Among the many concerns at Case study: much communication with Madam whom he had grown old with. Eventually, the Care his life and wished them well.
OTHER PHOTOS PIXABAY
the end-of-life, physical comfort Madam B had feared seeing blood B and her loved ones about her Team managed to send him home. Unexpectedly,
is incredibly important. Most and needles all her life. She said care and treatment preferences, the he slipped away peacefully in his sleep on the third
patients do not fear death itself she had zero threshold for pain. hospice team managed to ensure night. His sister told us that she hadn’t seen him
but fear the pain and distressing She pleaded with the hospice maximum physical comfort as so happy for a long time and she truly believed the We hope with these insights, we learn to be more
symptoms associated with the team to ensure that she did not defined by herself. final three days of his life were filled with joy. aware and are able to comfort our loved ones in
ways that matter most to them.
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THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
MAKING DAYS COUNT
Clockwise from far left:
Mr Tan Thian Huat, with
daughter Doreen, found
his place of comfort at
SACH; Mr Seow Yeow
Koon showed that life
can still be lived with joy
despite deteriorating
health; Madam Rafia’s
last Hari Raya Adilfitri
surrounded by family
Celebrating life, him to SACH. SACH became papa’s
second home, his place of comfort. Papa
celebrated his fulfilling last lap of life
creating memories
with our family and the care team in
SACH. He enjoyed a beautiful Chinese
New Year family reunion dinner and
his 72nd birthday celebration. Papa had
a very peaceful smile when he bade coaxed her to make her traditional kuihs
St. Andrew’s Community Hospital Care Team journeys with patients farewell to us at the well-lived age of 72. for other patients in the ward. They also
throughout their stay, maintaining the best quality of life within the Papa was a man who lived with courage, interviewed her and compiled her life story
optimism and perseverance even and last words for our family’s keepsake.
limitations of their illness as well as supporting their loved ones. when he was sick. The qualities in him Palliative care has taught our family that
reminded me to improve myself each it was no longer about counting the days
day,” shared daughter Doreen Tan. but making the days count. Thank you for
ogether with our patients and don’t want my life to be defined by illness. I “Our last Hari Raya Aidilfitri with my showing us that palliative care could be
T their loved ones, we celebrate
life at every opportunity. This
may take the form of lively
want it to be defined by the lives and hearts
of people I have touched through songs,”
shared Mr Seow. Lives and hearts were
grandma, Madam Rafia, was indeed
a memorable experience for our
family. In keeping with our tradition
this beautiful!” shared granddaughter Ms
Rohaida Rahmat.
WORDS & PHOTOS SACH PALLIATIVE CARE TEAM
singalong group music therapy sessions as certainly touched as he put up a special of family togetherness, we celebrated
well as individual sessions at the bedside, harmonica performance at St. Andrew’s the joyous occasion together with
birthday and festive celebrations, or even Community Hospital’s (SACH) Christmas her in Violet Ward of SACH. Despite
simple things like enjoying the sunshine in
the garden.
Celebration for patients. His performance
drew loud applause from the captivated
the additional palliative care needs
of oxygen and medications, our
Together with our
Mr Seow Yeow Koon, our late palliative
care patient, showed us that we could live
audience. Most importantly, it reminded
the patients, caregivers and care team of
grandmother never failed to smile
throughout. We created more beautiful patients and their loved
life to the fullest despite deteriorating health. the love and joy one can bring to others memories as my grandmother sang
Though he had cancer, Mr Seow maintained
a cheerful disposition and continued to
regardless of life’s circumstances.
“The blessed journey of our papa, Mr
along and participated actively in
SACH Grandparents’ and Parents’
ones, we celebrate life
enjoy his favourite pastimes — playing the
harmonica and eating his favourite food. “I
Tan Thian Huat, began after his diagnosis
of advanced stage cancer which brought
Day Celebration. The healthcare team
explored my grandmother’s hobbies and at every opportunity
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THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
GETTING CONSENSUS HAPPENINGS
The final send-off
What happens when family members disagree on a patient’s end-of-life care?
A positive intervention may be the panacea.
hen an individual is Left: Madam Tan Sai
W
Tin enjoyed a full life
very sick, the onus till her last days; Below:
of making decisions A photo of Madam
Tan Sai Tin (in blue) on
on care planning an overseas trip
often falls on the family. In some
cases, a difference of opinions
may arise within the family on the
right way forward.
Such was the case with Madam
Tan Sai Tin, who had stage 4
liver hardening, renal failure, and
diabetes before she passed away
in her 80s. She was then under the
care of MWS Bethany Nursing Home
- Choa Chu Kang, where a dedicated
palliative care team met her medical,
nursing and comfort needs.
Some members of the family
supported Madam Tan’s decision to
leave peacefully, while others wanted
to pursue aggressive treatments to
prolong her life as much as possible.
A SPECIAL INTERVENTION
Assistant Chaplain at Methodist Welfare
Services Ms Chua Chiew Poh visited
Madam Tan and she could see that
Madam Tan was in great emotional
pain. Knowing the different views within
the family, Chiew Poh called for a family
gathering by her bedside.
Before the gathering, Madam Tan’s sisters
paid her a visit to discuss next steps in her
care plan. The family finally came to an
agreement to fulfil her wish of not pursuing
further treatment.
WORDS & PHOTOS METHODIST WELFARE SERVICES
When the entire family came together
that day, they shared their love for Madam
Tan, asked for her forgiveness and also
extended their forgiveness. Through Chiew the lives of her loved ones over the years.
Poh’s facilitation, they were able to express Although she was unable to speak by then,
themselves in ways they usually would not. she responded with tear-filled eyes. It also
“As an Asian family, we aren’t used to brought a sense of peace to both Madam
expressing our love for our aunt,” said Tan and her family, with both sides ready to
Ms Wei Leng, Madam Tan’s niece. “This say goodbye.
bedside closure brought a sense of “The bedside closure benefited my family
completion to her final journey.” tremendously and I hope more families will
The session allowed Madam Tan to feel experience this too because it was really,
the positive impact that she had made in really special to us,” said Wei Leng.
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THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
COMPLETE HOME CARE
This care stage is especially them of the importance of helping
challenging, often fraught with the patient to realise her one last
the need to make complex end-of- wish,” shared Tsao Foundation
life decisions and arrangements. Senior Counsellor Gladys So.
Having an interdisciplinary care “Some patients might not be
team helps: a medical doctor helps conversant or might not hear
to administer the Advance Care what you’re saying clearly at this
Plan (ACP) and Advance Medical stage too but they will be able
Directive (AMD) in addition to the to feel your presence with them.
medical aspects of care; a social Sometimes small gestures go a
worker helps with getting a better long way without you knowing
understanding of and addressing — try applying hand moisturiser
psychosocial needs and care for your loved ones, or having
coordination; and a home care conversations with them despite
nurse makes home visits as well as and other arrangements. Our their unresponsive state while
assists on all clinical matters, such Counselling and Coaching team caressing their face and rubbing
as basic health monitoring, dietary does a Planner for Dying Well — a their shoulders, or playing their
advice, medication adherence, to wish list to guide the caregivers and favourite tunes,” said Cinthia.
name a few. their loved ones on starting this An avalanche of emotions
A care team such as that of HMMC conversation which has been quite awaits the elders, their family and
comes with an after-office-hours useful so far,” said HMMC Senior caregivers — sorrow, anxiety, anger
helpline. “Yes, this emergency Social Worker Jasmine Wong, when and denial, or perhaps even relief
number is important, along with the asked what could be of importance that a loved one’s struggle is at an
number for last-rite arrangements. at this care stage. end, or guilt that they have been
Keep them in mind in case of “In fact, at this end-of-life stage, I let down. The palliative care team
emergencies so that you won’t need find that at times, too many cooks will also need to be prepared to
to panic when something urgent or spoil the broth. Sometimes you get support this avalanche of emotions
death happens. It’s about staying so many family members all talking in their patients in addition to
calm and knowing that the palliative and discussing and going through addressing practical medical and
End-of-life journey with
team will support the symptoms the preparations to help their loved social needs at this most critical
management of your loved ones, ones that unknowingly, nobody has of one’s life stages. However, work
thus allowing you to spend been really listening to the sick elder does not end with the demise of the
meaningful time with them instead,” who has but one wish. I remember elder but continues with follow-
a community care team HMMC Senior Staff Nurse Cinthia
Lim advised.
“Communications is the most
important thing to do at this stage
vividly one patient who told me that
she just wants to go to church one
last time. But her family members
were all so busy arranging for
up sessions with the caregivers
to check on their well-being and
grief management. The team also
organises an annual memorial
For elders who prefer end-of-life care in the familiar setting of too. No matter how difficult it is, weekly visits and communion from service for caregivers who lost
caregivers should always talk to their pastor that none of them their loved ones. The event is
home, community care teams are the answer. their loved ones and families about heard the patient’s wish. So I had to a nice ending for reflections,
the situation and what to expect intervene and convey the patient’s remembrance, and celebration of a
next, about the various care plans wish to the family, and convince life well spent.
ua Mei Mobile Clinic and a day centre to counselling such as constipation, nausea, or
H (HMMC) was set up in
1993 to support frail
older persons to live at
programmes, the HMMC team has
the added advantage of being able to
refer clients to this care hinterland
shortness of breath. However in
HMMC, we take this step further
and aim to make the end-stage
“
home till the end. A team comprising for further biopsychosocial journey of our clients a joyful and
WORDS LIM YENG PENG, COMMUNICATIONS MANAGER,
TSAO FOUNDATION IMAGES FREEPIK.COM & PIXABAY
a doctor, nurse and social worker intervention and support, such fruitful one for all partners in care
jointly assesses, formulates, as engaging counsellors to work as this is not a mere journey for
implements and monitors a with caregivers and elders on the elder, but a journey for his/her
biopsychosocial care plan to provide stress-related, family-dynamic and family and caregivers too. Thus the
comprehensive care for these elders. psychological issues. This integrated, care team will involve the family
The end-of-life component was
started in 2010 as there was a need
personalised biopsychosocial care
at this end-stage of life is vital, but
and caregivers in everything we
do — discussing the prognosis and
Communications is the most important thing to do
for a different, more intensive work
process for frail elders nearing the
often not practised.
“In palliative care, much of our
advance care plan, prognostication,
accessing and coordination of at this stage. No matter how difficult it is, caregivers
end of their lives. attention is usually focused on community resources if need be,
Being part of Hua Mei Centre for
Successful Ageing which comprises
helping to make our patients’ end-
of-life journey as comfortable and
screening and monitoring the elder’s
condition as well as that of his/her
should always talk to their loved ones and families
a suite of community-based care pain-free as possible, including the caregivers,” said Tsao Foundation
services from primary care clinics management of other symptoms, Clinical Consultant Dr Ng Wai Chong. about the situation and what to expect next”
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THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
SHC OUTREACH
LIVE
LIVE
Singapore Hospi
ce Council is live
Singapore Hospice Council is live now now
HeARTS in ACTion:
a virtual celebration
It is never too early to act on our end-of-life care plans.
After all, life is about Living Well and Leaving Well.
Singapore Hospi
Singapore Hospice Council ce Council
Launching the trai
ler of SHC’s short
Hello from today’s hosts Nick Shen and Vanessa Tan (L to R): Host Nick film The Sketchboo
Shen, Mr Titus Lee k in 3, 2, 1!
Leong (Chief Execut , Dr Chong Poh He
ive of SHC) and Ho ng, Ms Evelyn
his World Hospice and Palliative Advance Care Planning. The videos 2 5 st Vanessa Tan.
T Care Day, Singapore Hospice
Council (SHC) celebrated with a
two-day virtual event on 9-10
were live-streamed on SHC’s Facebook
and SISTIC, and to date have garnered
more than 8,500 views combined.
LIVE LIVE
October 2020 to honour the contributions To further equip the public with Singapore Hospice Council is live now Singapore Hospice Council is live now
of our healthcare workers, caregivers and knowledge from professionals on
volunteers in the palliative care sector. palliative care and end-of-life care
More importantly, the event hoped to matters, SHC jointly organised webinar
increase awareness of palliative care and sessions in English and Mandarin with
encourage people to take early steps in the Agency for Integrated Care on 24-
their end-of-life care plans by doing their 25 October 2020 respectively.
9 OCTOBER
Singapore Hospice Council Singapore Hospice Council
A warm welcome from Dr Chong Poh Heng, Vice Chairman of SHC. Encouraging words for our palliative care professionals from
Edmund Chen – actor, author and Guinness World Record holder
3 6
Hosted by Junior Chamber
LIVE Internationl (JCI) Ten
Outstanding Young Persons LIVE LIVE
ncil is live now
Singapore Hospice Cou
of the World 2014 Honoree,
actor Nick Shen and 2015 Merit Singapore Hospice Council is live now Singapore Hospice Council is live now
winner, presenter Vanessa Tan,
and graced by our Guest-of-
WORDS & PHOTOS SINGAPORE HOSPICE COUNCIL
Honour, Mr Titus Lee, Director
(Aged Care Services), Ministry
of Health, Day 1’s programme
started off with a bang. Artistes,
healthcare workers and
volunteers graced the stage with
their heartfelt performances.
Following the 45-minute
entertainment, meaningful
ncil conversations transpired with
Singapore Hospice Cou ance from Buddhist
is a drumming perform our guest speakers on palliative
Starting the programme nda tion (Singapore)!
Singapore Hospice Council Singapore Hospice Council
ief Tzu Chi Fou Duet of “关怀方式” with Dr Alex Su (Chief of Recovery Care
Compassion Rel care, end-of-life care planning Opening message from the Guest-of-Honour, Mr Titus Lee,
Director of Aged Care Services, Ministry of Health. Department, Institute of Mental Health) and Tan Yuqing (2nd runner
1 and volunteering. up of SHC 2019 Voices of My HeART Songwriting Competition)
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THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
SHC OUTREACH
LIVE LIVE
LIVE Singapore Hospice Council is live now Singapore Hospice Council is live now
10 OCTOBER
Singapore Hos pice Council is live now
LIVE
Singapore Hospi
ce Council is live
now
Singapore Hospice Council Singapore Hospice Council
Daniel Ong (winner of SHC 2019 Voices of My HeART Songwriting It’s official – SHC’s short film The Sketchbook is now live!
Singapore Hospice Cou
ncil Competition), performs his winning song “阿嬷的歌” composed by Goh
dfulness, joined by
ortant message on min Seow Ting. The lyrics were inspired from SHC’s Life Book Granny Cool,
Dr Alex Su gives an imp 1
Ms Evelyn Leong. and the background illustration was extracted from the book
11
8
LIVE LIVE The highlight of Day 2’s the help of his loved ones
Singapore Hospi
programme was the and caring nurse, his ce Council
Insightful sharing abo
ut dealing with dea
Singapore Hospice Council is live now Singapore Hospice Council is live now screening of SHC’s first dream of holding his own Nick Shen (caregive
r), Nicole Peng (Se
th and palliative car
e from
from HCA Hospice nior Palliative Care
short film The Sketchbook art exhibition became a Park Hospice Home
Care) and Dr Yee
Choon Meng (Head
Nurse
Care Service). Mo of Dover
which was inspired by a reality. This was followed Singapore Film So
ciety.
derated by Sherm
an Ho from
2
true event. It tells the story by a live panel discussion
of how a young artistic on coming to terms with
boy suffering from cancer dying, joined by the actual
found friendship in a nurse who attended to If you have missed the two-day event on
palliative care nurse during the young patient in the 9-10 October, you can still watch the
the darkest moments of the film, a palliative care broadcasts on SHC’s Facebook at
his life. In the end, with doctor and caregiver. www.facebook.com/singaporehospice
Singapore Hospice Council Singapore Hospice Council
Lovely sign language performance of “Give Love” by a group Indeed, “these little things we do can make a big difference”
of nurses and therapists from the home palliative care team at
Buddhist Compassion Relief Tzu Chi Foundation (Singapore) and
host Nick Shen, an active volunteer there.
Tan Yuqing and 28 representatives from SHC and her member
organisations come together to present “Journey” – written,
composed and sung by Yuqing.
“Palliative Care and End-of-Life
9 12
Care Matters” Webinars
LIVE LIVE 24 OCTOBER (ENGLISH) 25 OCTOBER (MANDARIN)
Singapore Hospice Council is live now Singapore Hospice Council is live now
Chong Poh Heng Clockwise from top
Singapore Hospice Council Clockwise from top left: Speakers Dr SHC, Chief and Sen
left: Speakers Dr Koh
Lip Hoe (Council Me
Singapore Hospice Council tor of HCA Hospice Care) and
SIMmeriNG performs “Me & You”, composed by a group of Republic (Vice Chairman of SHC, Medical Direc General Hospital),
ior Consultant of Pal
liative Care Service
mber of
Host Nick Shen, Edwin Sim and guest speakers, Dr Chong Poh of SATA CommHealth). Mr Dan Chan and Ms s in Changi
Polytechnic students from the Diploma in Sonic Arts course for their Mr Sammy Leong (Case Manager Hougang Sheng Ho Ch uah Xing Jun (Social
Heng and Dr Raymond Ng (Head of Palliative Medicine Department volunteer).
2019/2020 Final-Year Project. The duo, volunteer Edwin Sim and Facilitated by Mr Edwin Sim (SHC ng Family Service Ce
(Social Worker at Life ntre). Facilitated by
Workers at
of Integrated Care, Woodlands Health Campus), discuss about Point - Society of She Mr Peter Mao
Andrew Ng (Lead, Culture and Organisational Development) are from ng Hong Welfare Ser
palliative care, end-of-life care planning and volunteering. vices).
HCA Hospice Care
10 13
14 15
THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
GOING FOR CLOSURE
Regrets,
reconciliation, “
Through
resolution conversation,
What truly matters at the end of life? Addressing unresolved hurts we try to unpack
and regrets bring much-needed peace before death.
these emotions to
he sobering reality of impending help them assign
T death often spotlights unresolved
hurts and regrets. Fragmented
relationships, old wounds and meaning to events
nagging regrets are brought to the fore, as we
approach the end of life.
This can result in total pain, a concept
that are often out
determined by Dame Cicely Saunders, the
founder of the modern hospice movement. of their control”
It is a complex and deep pain that affects
one’s physical, psychosocial and spiritual
well-being, arising from issues left unresolved
over the years. While there is no turning back, it is
A core aspect of holistic palliative care is to important to help patients process how they
provide psychosocial and spiritual support feel and empower them to find meaning and
for patients and their loved ones. Oftentimes, acceptance. “Through conversation, we try to
this encompasses journeying with them unpack these emotions to help them assign
through thorny issues and enabling them to meaning to events that are often out of their
find resolution. control,” said Paul. “After all, no one chooses
to fall sick.”
COMMON REGRETS
Hindsight often brings clarity to deep-seated MENDING CRACKS
regrets, previously obscured by the daily Fractured, estranged relationships are a
grind of life. When hectic routines come to common source of emotional pain for many.
a screeching halt, the resulting void creates These could include old hurts spanning
time and space for reflections. “Many patients decades, temporarily suppressed by the
wished they had spent more time with their hustle and bustle of life. But when patients
children and family,” explained HCA Medical approach the tail end of life, these old wounds after the conversation and he passed Above: HCA Medical
Social Worker Paul
Social Worker Paul Bashyam. often resurface, sometimes manifesting on peacefully shortly after,” Irene said. Bashyam with a
This is especially common for older men, as physical pain that can’t be alleviated Oftentimes, the act of sharing brings patient at the hospital;
Opposite page:
who typically took on the role of main by painkillers. about therapeutic effects. “By opening HCA Spiritual Care
breadwinner for the family. While their efforts HCA Spiritual Care Counsellor Irene Lee up about their hurts and woes, this Counsellor Irene Lee
(right) with HCA
enabled them to support the family and put recounts an elderly patient who remained in allows them to let go and in turn Senior Palliative Care
WORDS & PHOTOS HCA HOSPICE CARE
food on the table, they often feel they had great pain, no matter the dosage of painkillers reduces their physical pain,” Irene Nurse Miao Lan and
a patient on an outing
missed out on the companionship of their administered to him. “He said he was holding explained. “It can also improve their during Christmas
loved ones, trading precious family memories on for forgiveness from his estranged wife,” relationships with their loved ones.”
for the demands of work. Irene shared. Everyone hopes for peace, no matter
When the patient’s days are numbered, he Despite his wife’s initial reluctance to visit which stage of life they may be at. By
or she may experience guilt and regret at him, she was eventually persuaded by the resolving old conflicts and hurts and
missing out on quality time with loved ones family. While there were no words of affection making the effort to spend quality time
in the past. “Patients might hate how things or tenderness in their final conversation, it with loved ones, this enables patients
are now and act out, wishing they didn’t have was clear his wife had forgiven him for his to depart peacefully and leave a legacy
to burden their family,” Paul elaborated. past transgressions. “He was visibly relaxed of love.
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THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021
THE FINAL WISH
“
Family is like music…
some notes are high,
and some are low… but
together we always
make a beautiful song”
JESSE JOSEPH
Mr Z’s last wish was to have lunch with
his family. He wanted an opportunity to express
his love and seek forgiveness from them.
Nurse Nur Atika bte Saad Singapore Cancer Society (SCS) approached
getting ready to welcome Ambulance Wish Singapore (NGO) to provide the
another patient
necessary resources to help fulfill Mr Z’s wishes.
I was present to provide medical support during
the family lunch. I was overwhelmed with
emotions at that time. I recalled a beautiful quote
Walking the last journey
from writer Jesse Joseph: “Family is like music…
some notes are high, and some are low… but
together we always make a beautiful song”.
In my opinion, it is essential to explore the
Lessening emotional and spiritual pain also helps with contributing factors that are associated with
the symptoms that patients portray. Sharing of
the reduction of physical pain in the end. WORDS NUR ATIKA BTE SAAD, STAFF NURSE, HOSPICE experiences from other patients will help them
understand that they are not alone in facing the
CARE SERVICES, SINGAPORE CANCER SOCIETY
endgame. As a nurse, building trust and rapport
n 2019, Mr Z, 46, was diagnosed with with his band for performances. As such, he chose with patients is most important at the start of
I cancer of the rectosigmoid which had
metastasised to his liver and bone
with a prognosis of three to four
his passion over his family and neglected his duty
to serve God.
Mr Z had an estranged relationship with his son.
the end-of-life journey. Respecting every patient’s
personal beliefs, emotions and needs as an
individual is crucial to build that trust.
months. His main symptom was pain and had to Maintaining patient-nurse confidentiality, I managed With only about six months’ experience in
have multiple hospital stays for pain crisis. to speak with his son and explained his father’s end-of-life care, I felt fortunate to have walked
He experienced not only physical, but emotional regret of the choice he made years back. Eventually, with Mr Z on his cancer journey. There is still
and spiritual pain, too. Being a man of few words they managed to put aside their differences and so much to learn and explore given my limited
he once told me of his deep-seated guilt that reconnected. Having attained closure with his experience in palliative care.
haunted him whenever he closed his eyes. As a family, and expressing his emotional and spiritual Thank you, Mr Z, for being part of my learning
passionate musician, he needed to travel overseas pain, helped reduce Mr Z’s physical pain. journey. Rest in peace.
18 19
THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021NO EFFORTS SPARED
Love and
devotion
magnified
Opposite page: Madam
R and her caregivers
with TTSH Drs T Yung
and L Wiryasaputra
& the Hope Medical
Ambulance crew; Left:
Dr. Raymond Ng and
A couple fought against part of the medical and
nursing team who cared
all odds to get a flight for Madam R; Below:
Senior Medical Social
back home to India in the Worker Corinne Lee
who supported Mr M
midst of COVID-19 border throughout Madam R’s
countless admissions
to TTSH
lockdowns in order for
the wife to fulfil her last
Madam R deteriorated to the extent The Head of the Palliative Medicine
wish of reuniting with that she was on the brink of death. Department Dr Mervyn Koh, together
their children. As the outlook was bleak, the team with the ward consultant-in-charge
began discussions with Mr M on Dr Raymond Ng went down to the
the arrangement of Madam R’s last Air India Office the evening before
rites. In the event of death, sending the flight to purchase the plane
ransferring a patient Madam R’s body back to India also tickets but they were told that a
T onto an empty plane
which just landed from
Chennai (a COVID-19
presented logistical challenges.
There was no direct cargo flight to
Trichy and the next nearest airport
Medical Board in India had to accept
Madam R before they could issue the
tickets. They wrote a medical report
hotspot in June 2020) felt surreal. was Delhi. It would take about on the spot to aid in the appeal.
The crew on board the plane were three days by land and clearance of Together with assistance from Air
in Hazmat suits and barely spoke multiple immigration checkpoints India, the Civil Aviation Authority of
any English. Thankfully, the captain in order to get home. However, as Singapore (CAAS) and Singapore’s
graciously accepted our 42-year-old Mr M shared, it is the Indian custom Ministry of Foreign Affairs (MFA)
patient Madam R, who was on a to lay the departed to rest as soon liaising with the Singapore consulate
tracheostomy and required oxygen as possible and he would then have in Chennai, approval to fly was
and medication to control her pain By June 2019, Madam R’s cancer her physical needs, hugged her no choice, but to choose the least granted just four hours before the and she was eventually transferred
and breathlessness on board. had relapsed, and it progressed when she needed encouragement, preferred option of cremating her flight’s departure! It was then a race back to her hometown with Dr
Before her diagnosis of stage 4 rapidly despite several cycles of and allayed her distress over DR TRICIA YUNG, CONSULTANT, TTSH; MS CORINNE LEE, SENIOR
body and bringing her ashes back against time to prepare Madam R for Mohan’s assistance to be with the
throat cancer in early 2018, Madam R chemotherapy. By April 2020, her her physical changes from her instead. This would mean that her the flight including giving her blood rest of her family.
MEDICAL SOCIAL WORKER, TTSH PHOTOS PROVIDED BY TTSH
WORDS DR LYNN WIRYASAPUTRA, RESIDENT PHYSICIAN, TTSH;
worked night shifts so that she could oncologist broke the bad news cancer. He knew of her strong children and family would not have transfusions. Two ward doctors Madam R passed on peacefully in
care for their two children in the that she was no longer able to give desire to return home and a chance to see her again. accompanied her directly onto the the comfort of her home and with
day, while her husband was at work. Madam R further chemotherapy. persistently petitioned the Indian Thankfully, Madam R plane via a direct tarmac transfer her loved ones surrounding her on
Unfortunately, Madam R’s cancer Knowing that her days were High Commission to book tickets miraculously pulled through and by ambulance to ensure that her 28 June 2020. As Mr M gratefully
treatment which included surgery, numbered, Madam R wished to back to India for them during the stabilised. Although it was a huge anxiety was allayed and that she said, based on his own efforts,
chemotherapy and radiation therapy, return to her hometown to be with COVID-19 pandemic. risk for her to fly, her desire to was kept comfortable all the way. this flight back would not have
took a toll on her physically and she her children, whom she has not There were high hopes initially return home still burned strong. Despite some initial hiccups at the been possible without the hard
could no longer care for them. Her seen for more than a year. when Mr M was told that there As such, the team threw caution to airport, Madam R was finally able work of a multidisciplinary team,
own care needs had increased, and Her husband Mr M was a faithful would be a flight back to Trichy, a the wind and swung into action to to board the plane home on 10 June as well as external support from
her husband faced challenges in companion, a devoted caregiver major city near their hometown make arrangements to fly her home. 2020. She arrived safely back to generous sponsors, the Indian High
having to care for her, their children and an unwavering supporter in mid-May. Unfortunately, Mr M The next available scheduled flight India that same night and Dr Mohan, Commission, MFA, Air India and
and work simultaneously. The couple throughout Madam R’s journey was unable to get a confirmed was full but with assistance from Medical Director of Sudharsana CAAS officials. All brought about
had to make the tough decision to with cancer. He is a small-built flight as India continued to extend the Indian High Commission, they Palliative Care Hospital in Trichy, the long-awaited family reunion
send their young children back to man but has a big heart and its lockdown. Two weeks later, appealed to three foreign workers, took over her care upon her arrival. and the fulfilment of a mother’s
India in early 2019 to be cared for by unconditional love for his wife. He while waiting for further updates who generously gave up their seats Madam R’s children were joyfully wish to see her children for the
Madam R’s younger sister. visited Madam R daily to attend to of possible flights back home, for Madam R and her family. reunited with her at the hospital very last time.
20 21
THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021TEAM SUPPORT
turned out to be quite an ordeal for her. The She felt better and continued to keep in touch with
nurse was at a loss for words when the family the MSS team.
members began to ask her about the patient’s
fading health and was unsure how to properly SUPPORT TOWARDS PATIENTS
comfort them. The Demise Patient Debrief has been on-going
To help the care team overcome such fears, for eight sessions now. Through it, the palliative
Prabha conducted counselling sessions for the team at SKCH is able to stay connected and inspire
nurses that helped to address their emotional one another.
needs. She advised the nurses to approach the The final stage of a terminal illness can be
MSS team or their colleagues whenever they challenging for both patients and their caregivers.
needed support. A care team that is armed with knowledge and
Prabha also coached them on how to connect confidence can help to provide comfort and
with patients’ family members by providing support the families to deal with grief and make
some communication tips. This would help final decisions.
them to address concerns by patients and their Equally important is the support given to staff
caregivers and understand their needs without who may deal with the passing of patients on a
any apprehension. regular basis. Knowing that someone will be at their
For the nurse who shared her story, being side gives them the assurance that help is always
Help is just around
new to caring for palliative patients, she needed available to them.
time to adapt. With guidance from experienced A frequent reminder from Prabha to the care team:
colleagues, she was eventually able to work well “Remember you are doing a great job in caring for
and grew to like her work on the palliative ward. our palliative patients. You are not alone in this!”
the corner
A care team that is armed with knowledge
Workplace actions can lead to many different emotional responses. and confidence can help to provide
The Demise Patient Debrief initiative at Sengkang Community Hospital
allows staff to share their concerns and be supported in a positive comfort and support the families to deal
work environment so that they can provide the best for our patients.
with grief and make final decisions.
t is never easy dealing with the two weeks to prepare for the first session which
I topic of death. While there are
many forms of support in palliative
care focusing on patients and their
saw participation from the allied health, medical
and nursing teams.
family members, behind every palliative story is COPING WITH PALLIATIVE CARE
also a strong and dedicated healthcare team. The first session lasted for almost two hours.
A confident and devoted care team will It kick-started with a short icebreaker where
ensure the best outcome for patients and their everyone introduced themselves and shared how
caregivers’ physical, social, emotional and they were coping on the palliative care ward.
WORDS & PHOTOS SINGHEALTH COMMUNITY HOSPITALS
spiritual needs. This support makes death less “It was nice to hear from everyone in the care
frightening and more about how to obtain peace team. While we see each other every day on
and dignity for the patient. the ward, we seldom get to talk about our own
On 25 June 2020, Sengkang Community feelings and perspective, especially as a palliative
Hospital (SKCH) started its first Demise Patient team member,” shared SKCH Nurse Clinician
Debrief Session to provide support for its Nagavali D/O Letchumanan.
palliative team and have them reflect on After the check-in, the team then proceeded to
patients who have passed on. bring up and discuss various challenges faced by
“Our Medical Social Workers worked with our patients and family members, their expectations
nursing colleagues to materialise this project as and coping with staff’s emotional stress.
we felt it was important for the palliative team “During the session, a nurse shared with us
to share how they feel and cope with patients’ about her experience in caring for a patient who
demise,” shared SKCH Senior Medical Social passed on during one of her shifts,” said Prabha.
Worker (MSW) Prabha D/O Techna Mitti. It was her first time working overseas and
It took the Medical Social Services (MSS) team caring for palliative patients, and this experience
22 23
THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021 THE HOSPICE LINK • DECEMBER 2020 – FEBRUARY 2021ANNOUNCEMENTS
Celebrate SHC’s 25 Years of Impacting Lives!
Listen to the Soundtrack of Shop at our
SHC – 25 Years Journey album Charity Art
Listen to seven meaningful songs, Sales site to
comprising the three winning raise funds
composition pieces from SHC’s for SHC
2019 Voices of my HeART (VOH) More than
Songwriting Competition, composed 50 pieces of
pieces by Republic Polytechnic final- artwork by
year students and the song “Journey” local and
by a 2019 VOH winner who stepped overseas
Watch SHC’s first short film forward to lend her voice. For the full artists are
The Sketchbook album, visit https://bit.ly/3jyOubz. up for sale,
Discover how a young in various
artistic boy suffering from media
cancer finds friendship in ranging
a palliative care nurse and from Chinese ink painting
achieves his dreams during and calligraphy, to Abstract
the darkest moments of his and Realism oil and acrylic
life. Inspired by a true event, paintings. Up to 80% of the
their friendship continues sales proceeds will be donated
to live on and will never be to SHC. For more information,
forgotten. For the full film, visit https://fundraise.
visit https://bit.ly/37RVnCS. singaporehospice.org.sg/.
EDITORIAL COMMITTEE CALENDAR
Editor Christina Wee 16 DEC 2020 – 19 JAN 2021
Associate Editor Anne Loh SHC @ Woodlands Regional Library
Explore and learn more about palliative care and
Alexandra Hospital Yvonne Lee end-of-life matters through stories, digital resources,
Assisi Hospice Angela Yeo a photo-documentary and more at the exhibition!
Buddhist Compassion Relief Tzu Chi Editorial Team Venue: Level 1, 900 South Woodlands Drive, #01-03,
Tzu Chi Foundation (Singapore) Singapore 730900
Changi General Hospital Rasidah bte Alias
Dover Park Hospice Jenny Goo *In view of the COVID-19 situation, please check our
HCA Hospice Care Toh Wei Shi website www.singaporehospice.org.sg for updates.
Khoo Teck Puat Hospital Tricia Tan
Lien Centre for Palliative Care To be advised
Metta Hospice Care Cecilia Soh
MWS Home Care & Home Hospice Nicolette Yeo
The Palliative Care Centre for Tan Li Kuan
Excellence in Research and Education
Sengkang General Hospital Farah Rahman
Singapore Cancer Society Kumudha Panneerchelvam
Singapore General Hospital Mavis Law
Singapore Hospice Council Sheena Koong
SingHealth Community Hospitals Muhammad Azhar bin
Abdul Rahim
St Andrew’s Community Hospital Peh Lay Koon
1 Lorong 2 Toa Payoh #07-00, Braddell House, S (319637)
St Joseph’s Home Shereen Ng
T: 6538 2231 • E: secretariat@singaporehospice.org.sg
St Luke’s Hospital Chua Hwee Leng
www.singaporehospice.org.sg
Tan Tock Seng Hospital Candice Tan
Tsao Foundation Desiree Lim
Design Christian Subrata Contents are not to be quoted or reproduced without the prior
Printer Yung Shung Printrade Pte Ltd written permission of the Singapore Hospice Council.
24
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