A day in the life of a palliative care clinic in Keralahttps://indianexpress.com/article/india/kerala-euthanasia-passive-pallative-healthcare-terminal-illness-the-final-hours-5146794/

A day in the life of a palliative care clinic in Kerala

A day in the life of a palliative care clinic in Kerala: A state with 3 per cent of the country’s population, Kerala offers close to two-thirds of the total palliative care in the country, aimed at alleviating suffering and making death, in cases that it is inevitable, more peaceful and dignified.

Head Nurse Suvarna with a 19-yr-old in terminal stages of stomach cancer. “God has to decide,” says his mother. (Express Photo by Vishnu Varma)

It’s 11 am and the morning hasn’t begun well at the Anwar Memorial Pain and Palliative Care Society. “Oru marippu undu innu (There has been a death today),” whispers C M Salim, the secretary of the society that runs this palliative clinic in Aluva, 20 km outside Kochi.

About 10 minutes later, a stretcher carrying a man in his 50s is wheeled out, followed by his friends and relatives, and checked into a waiting ambulance. “It was a case of pancreatic cancer. He was 53 and the only earning member of the family. He is survived by his wife and two children,” says Suvarna, the head nurse at the clinic. “Nothing more could have been done for him,” she adds.

A state with 3 per cent of the country’s population, Kerala offers close to two-thirds of the total palliative care in the country, aimed at alleviating suffering and making death, in cases that it is inevitable, more peaceful and dignified.

The Supreme Court’s landmark judgment recognising the right to live with dignity, including easing the process of dying for the terminally ill, underlines the need to fill this palliative gap.

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The Anwar Memorial Pain and Palliative Care Society, attached to the Anwar Memorial Hospital, began in 2002. It provides end-of-life medical care to terminally ill patients from impoverished families. Eighty per cent of the inmates in its 10-bed ward are in terminal stages of cancer, or suffer from paraplegia and kidney failure. Patients come here mostly after extensive chemotherapy and radiation sessions, drained financially, emotionally, physically.

“We neither extend the days of those who come to us nor do we cut the days. When patients ask me whether they will live, I say, ‘It looks serious… you will take some time to recover’. That way, I am neither lying nor giving the patient false hope,” says Dr T M Hyder Ali, the resident doctor at the clinic and the chairman of the society that runs it.

Just then, an elderly woman who is assisting her husband on a wheelchair, peeps in through the door of his office and says, “Please pray for us.” “Everything will be fine,” Dr Ali smiles and reassures her.

“Her husband wants to go home, so he is getting discharged. The cancer began in his tonsils, but it has spread everywhere,” he says, adding that patients can stay as long as they want. Food and basic medicines such as morphine are free for all, including those who can afford the daily rent of Rs 150 for the five private rooms at the clinic.

Three days a week, the two staff nurses, an attendant and a doctor go for ‘home care’, to homes of patients in need of medical care.

Today, there are only four patients at the clinic, one in the ward and three in the private rooms.

Around 1 pm, Suvarna, one of the two nurses, starts her round of the ward. Her nine-hour workday typically involves administering patients their medicines, checking for bed sores, dressing wounds, and setting up IV fluids and catheters. However, as she points out, the most important part of her job is offering emotional support to those who know they are dying.

“When I started working here, it was tough for me to deal with so many deaths. It took me to the verge of depression as we get attached to patients and their families,” she says.

Today, the sole patient in the ward is a woman in her 70s who has thyroid cancer. Surrounded by her family, the woman cries out in pain. “She was brought in yesterday. Because of infection in the thyroid, there has been uncontrolled bleeding,” Suvarna whispers, before patting the woman’s cheeks and assuring her that she is around to help.

Suvarna then proceeds to the rooms. A patient in his 60s, suffering from rectal cancer, is deep in sleep in one of the rooms. “The cancer was diagnosed over a year ago. He was sad initially, but now he doesn’t talk about it anymore. He just sleeps all the time,” says his wife.

One of the rooms has a 19-year-old in terminal stages of stomach cancer. “He has been here 13 days and we are all emotionally attached to him… but the disease isn’t looking good,” Suvarna sighs.

“Daivam nishchayikkanam (God has to decide),” says his mother Sudha, sitting by her son’s bedside, adding that she hasn’t lost hope.

Around 2.30 pm, the patients and their relatives get kanji (rice gruel) for lunch. “The food is sponsored by donors,” says Suvarna.

With fewer patients around today, Suvarna and Nelcy, the other nurse who joined a week ago, use the next couple of hours to fill in patient information forms, stock up on medicines from the pharmacy, and roll out tiny cotton balls for patients to use.

At 5 pm, Dr Ali makes his final round of the day. He asks each patient about their condition, and leaves instructions with the nurses and the relatives on the medicines and dosage to be given to ease the pain. “Don’t give him too much sugar in his tea,” he tells a patient’s wife. “Make sure he walks a bit, don’t let him lie down all day,” he instructs the family of another.

Stepping out of the 19-year-old’s room, Dr Ali looks anguished. “I can’t be optimistic about any of them. In this boy’s case, the situation is very bad — the cancer has spread everywhere. I hope the end, whenever it comes, is peaceful.”

Suvarna’s shift ends at 6.30 pm. “At night, nurses from the casualty section of the hospital (that is attached to the clinic) drop in to check on the palliative ward. But mostly, the relatives can handle things. They have been trained to,” she says.

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Packing up to leave, Suvarna adds how the next day being her off, patients might ask about her. “They keep asking, ‘Sister vanno (Has sister come)? So I don’t tell them if I go on a holiday. It’s better that way, isn’t it?”