Palliative ICU care

"I cannot stand it anymore! Stupid tumor. Stupid, stupid stupid tumor. Pain score is from 0-10. But pain score now is 12! This is so ridiculous. ( banging the table) Argg.. I’m sorry. I just cannot accept it that she is at a critical stage now.

I must be strong. I must be strong. ( holding back tears) I must be strong for her".


(Walked off sobbing and crying…)

M went into palliative critical care stage today. S/C haloperidol, IV morphine, insulin, buscopan, were infused into her frequently to ensure that her condition remains as best as we can do medically and for her pain level to remain at an acceptable range. Close monitoring was initiated to managing breakthrough pain and prevent undesirable side effects such as respiratory depression due to her high dosages of pain relievers.
It was a different kind of stress faced today as I became involved in the care of a palliative critical care patient. The goals of treatment and management were so different from those that I’m used to in an active emergency. The stress faced this time was about the comfort of the patient as she walks her final journey in life. It was close close monitoring as the drug dosages given were very high and complex. We have to play the role of palliative care coordinator and link between various health care members of different teams to ensure that the best care is given to the patient. Our job is also to help comfort both the patient and her loved ones as it can be testing in managing family members losing control of themselves, while keeping focused on the patient’s critical stage in front of us, as well as making sure that medical equipments and drugs required are preempt and obtained for availability of use.

The pastor, more relatives and friends arrived later to give M spiritual, psychological and emotional support. I don’t know if I will ever see her again when I next step into her room. I do not sense the prompting to pray for healing... But I prayed for the love of God to overshadow all her pain and sufferings, such that she can walk smiling into your arms. And for her loved ones to come to a closure with you as their strength and hope.