Make every minute count

(Third of four parts)

Businessman Dennis Ang passed away peacefully, surrounded by family praying with him. Palliative care took care of the medical part, said his wife Ramona, leaving the family free to focus on the emotional part.

“Palliative care involves pain management, nutrition and mental health,” says Dennis’s cousin, oncologist Dr. Marina Chua-Tan, who works with an interdisciplinary team to help patients and families cope holistically.

Physical pain is managed by palliative care doctors, but emotional pain is as acute. Even if some Filipinos balk at seeing a psychiatrist, insisting they are “not crazy,” many patients and their families need help.

“I help patients address the pain for which there is no morphine,” says psychiatrist Dr. Daphne Ong of The Medical City (note: she did not treat Dennis). Anxiety is “a normal reaction” upon receiving a dreaded diagnosis or to grief and the pain of loss—“loss of health, loss of mobility, loss of dreams.”

Today, Ong continues to provide therapeutic care to children, teens, adults, but she decided to specialize in a “neglected sector,” psycho-oncology, supporting patients with cancer. Medications are given as needed, often as a last resort, since “there are non-medical options that can help, such as therapy.”

I marvel that Dr. Daphne takes time to talk to patients, since some doctors spend just a few minutes to scribble antidepressants. “Patients deserve my time,” she says.

“What I like about my job is that this is not just patients battling cancer, but also getting a chance to reexamine their life. In this golden period, they have the privilege to prepare for the afterlife. With therapy, patients can prepare themselves and their family, strengthen relationships, say ‘thank you,’ ‘I love you,’ ‘forgive me.’”

In dignity therapy, patients create a document as a gift for loved ones, where they review their life and accomplishments, recall beautiful memories, share wishes and dreams. “When the family reads the document, they feel good; there is no need to guess. No regrets, no doubts.”

As a young doctor, Ong thought of going into other specialties, but buoyed by her faith, she reflected, “Patients want healing, but what is the healing for?” She pledged to help people face this question, and come to terms with mortality, in a society where death is still taboo.

When parents are diagnosed, children often refuse to disclose the terminal diagnosis, believing that ignorance is bliss. “Unfair,” says Ong, since this deprives patients the chance to make peace with their lives. Chua-Tan also cannot administer chemotherapy or other treatments to patients who do not know the facts.

I tell Dr. Daphne of people who do not want aggressive measures but are overruled by family who want to prolong their lives no matter what.

“Deep down, there may be guilt,” she says, adding: “Families want to do everything possible, but we need to allow nature to take its course. We cannot always control death. It is important to realize that acting upon patients’ wishes to withhold treatment or discontinue measures is not killing patients.”

Palliative care specialist Dr. Liza Manalo, who teaches bioethics at the Ateneo School of Medicine and Public Health, differentiates between natural death and physician-assisted death.

With natural death, terminally-ill patients decide against aggressive measures to lengthen life, opting for pain management with palliative care—doctors usually respect patients’ choice to die a natural death (even as family often do not want to give up). But in our predominantly Catholic society, physician-assisted death such as euthanasia is not an option, since the medical dogma is to do no harm.

Only a handful of psycho-oncologists are available in the country, and Ong is determined to increase awareness. She advises, “When the minutes in your life are counted, make every minute count.”

(Next week: Amazing grace)

Queena N. Lee-Chua is with the board of directors of Ateneo’s Family Business Center. Get her book “All in the Family Business” at Lazada or Shopee, or the e-book at Amazon, Google Play, Apple iBooks. Contact the author at blessbook.chua@gmail.com.