When you practically live in the hospital due to extended confinement of a family member, what do you do? My father suffered a stroke and we stayed there for three months straight. He would be in and out many more times later, until he finally succumbed after another month of confinement.

I was the caregiver assigned and only went home to sleep perhaps four times during that three-month period. Fortunately, I was given leeway to work remotely by my boss. And since we were a media firm focused on health, I would be given assignments to interview certain doctors.

One of the most interesting conversations I had was with pain management and palliative care specialist, Dr. Luzviminda Kwong. In the Philippines, awareness about palliative care among the public and even healthcare professionals is extremely low, and remains one of the physician's frustrations.

She's been in this specialty since 1994, but up until our interview colleagues have yet to fully grasp what palliative care truly entails, its benefits, and more importantly the comfort it provides.

There are three important things that people should understand about Dr. Kwong's specialization: first, it is not a cure. It is a form of caring, she explained. Her job is not to take over from the attending specialist taking care of the patient. Second, it is not only for terminal patients. And third, it is not a means to end life.

Relief not cure

A primary component of palliative care is pain management. Patients, especially those in the terminal stage of cancer, are usually in a lot of pain and only want relief. Often, they are also grappling with finances and are apprehensive about continuing with treatment that is mostly expensive.

Unfortunately, among the things that Dr. Kwong suggests to patients and their families is to stop treatment once she is called in. It's for practical purposes, she insisted. Why proceed with therapy that will no longer have the desired outcome, when a patient will benefit more if they are freed from excruciating pain.

The main objective in palliative care is providing high quality end-of-life care that will bring comfort to a patient and less stress to the family. This involves the administration of opioids such as morphine under her strict supervision to manage pain.

Managing pain

Providing the option to discontinue treatment and undergo pain management instead is perhaps one reason why other medical professionals are hesitant to propose this course of action to their patients.

It's also the use of opioids that other physicians are wary of, thinking it could eventually develop into an addiction. Perhaps they pass on this concern subconsciously to their patients, who then have second thoughts about seeking this therapy.

Dr. Kwong stressed that morphine, when administered properly, is not addictive. It will not cause damage to the liver or kidneys. It is safe for the very young (she mentioned a 4-year-old) and the elderly (70 years). It can even be taken on an empty stomach.

The specialist lamented that she is usually called in too late, and by then patients have had to endure pain far longer than necessary when she could have stepped in earlier to provide them relief. And families would have likely spent an inordinate amount of money, which they probably don't have.

Beneficial intervention

Palliative care is also available to patients with pain issues that are not manageable with the usual treatment protocols. Dr. Kwong related a case where an elderly patient developed pneumonia and was unable to expel mucus so suctioning was recommended. But given how painful this procedure is, the patient was adamantly against it.

Until Dr. Kwong suggested pain management. But the attending refused initially, arguing the patient was not a terminal case. Yet the intervention, once the patient and her family agreed to it, enabled painless suctioning and her pneumonia eventually resolved.

Not euthanasia

When families of patients seek Dr. Kwong, she makes it a point to get a sense about their understanding of what they want to happen. She typically asks families who call her one question: "What do you need from me, what do you want me to do?"

The most disappointing reply she ever got was: "Our patient is terminal, and we want you to manage him. Give him medication to make him sleep so he doesn't wake up."

This is not the answer she wanted to hear. As annoying as it was, she firmly but politely retorted, "Sorry, you made the wrong call."

Dr. Kwong is not in the business of ending life. Her purpose is to make life more bearable for people who know their time is coming to an end. Her wish is for the public and her peers to have a better appreciation of what her specialty is and how it is also an integral component of medicine.

Photos: Unsplash