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Advance Care Planning

Advance Care Planning

Mr Chow Yew Weng, a 61-year-old retiree, fought his cancer bravely for three years. When treatment did not work anymore, he decided that he wanted some peace to have quality time with his family and to die comfortably.

One of those few rare patients who was aware of his condition and clear about the level of care he wanted, his family members said that he had been preparing for end-of-life issues since his diagnosis, giving them instructions on how to settle his affairs.

Mr Chow made the decision to decline home care in favour of being placed in a hospice. In a discussion with a medical social worker at the hospice, he also expressed his wish for quiet and solitude, requesting to receive visits from only specific relatives.

His wife, Madam Leow Suat Lay, 55, said: “He had happy times with us. We had parties, with food and drinks and even children running around. He also managed a short mahjong session with volunteers. On Oct 1, he died peacefully in his sleep with me, our son and my brother by his side. We saw him take his last breath.”

Madam Leow, a nurse at the National Dental Centre, was touched by how he was taken care of at the hospice. She said, “The nurses there were fantastic. They were very caring. The pain management was also very good. He was comfortable,”

But Mr Chow’s road to a peaceful death was not without some hiccups.

He was diagnosed with stage 4 colon cancer three years ago. He had no symptoms until he felt discomfort from a distended abdomen. The cancer had already spread to his liver. He underwent an operation to remove the tumour in his colon, had 20 cycles of chemotherapy and then had surgery to remove the tumour in his liver. After that, he continued with chemotherapy.

But two weeks after his last chemotherapy session, his abdomen became distended and both his legs became swollen. He could not eat or sleep well and had double vision. “He was in a bad way,” said Madam Leow.

He was warded at a restructured hospital and, for the first time since his treatment started, became fearful of needles and pain, she said. He refused treatment at the hospital. He decided he had had enough and was ready to die. But he did not know how to go about telling doctors what he wanted.

At one point, doctors wanted to transfuse blood for him as his blood counts were low. “But it was very frustrating as his veins had all collapsed. They tried for hours but could not do it.

“All that poking for nothing even though we had said we didn’t want it,” Madam Leow recalled.

After two weeks in hospital, she received a shock when the doctors looking after her husband said that he could be discharged the next day.

“By then, he needed full-time nursing care and I had not prepared our home for it. There was no hospital bed at home and we did not have a maid. I did not know how I was going to look after him at home,” she said.

That was when Mr Chow decided Dover Park Hospice was where he would spend his last days.

“He had signed an advanced medical directive when he was first diagnosed. He never wanted to prolong his life unnecessarily. But we had always assumed that he would be in a terrible state and die in hospital,” said Madam Leow.

It was only at the hospice that she realised death did not have to be that way.

“Because he made all his decisions and the hospice supported him so well, I did not feel stressed from having to decide what to do for him. His death was very peaceful for him and for me,” she said.