Palliative Care

Dr M.R.Rajagopal MD | 01-July-2014

Dr M R Rajagopal

My father has advanced cancer in his liver. Two reputed oncologists have seen him. They feel he needs to have palliative care now. But he keeps going from doctor to doctor. Finally, one doctor in another city told him that a liver transplantation is a possibility. Now he wants to go there. He is really not in a condition to travel. When we tried to reason with him, he got angry and claimed that we were reluctant to spend money on his treatment. In addition to the sadness of losing him, we also have to deal with this accusation. What can we do? Should we take him wherever he wants to go?

Pradeep Shekar, Madurai

Your father obviously has a problem accepting the inevitable. This is not at all uncommon. Dr Elisabeth Kübler-Ross, who came to be called the “Death and Dying Lady” for her research into the dying process, called it the stage of “Bargaining,” When grieving over a loss (in this case, your father is dealing with the worst possible loss – the impending loss of his life), bargaining can take several forms. It can be with God like: “If only you will make ne better, God, I shall give up drinking and smoking.” It may actually even take the form of offering God a bribe. Or the person may go doctor-shopping or system-hopping, moving from one system of medicine to another, often losing a lot of money, and also precious time.

I use the phrase “precious time” deliberately. When his disease has been declared incurable, he has an opportunity to spend the remaining time doing what he enjoys most – maybe having a holiday by the seaside, playing with the grandchildren or dealing with “unfinished business,” But unfortunately, the bargaining process interferes with those. It will be sad if he keeps himself so busy running after an impossible cure that he gets exhausted and is unable to enjoy the remaining time that he has in the world.

He needs a counsellor – someone who will not keep arguing with him but instead will listen. The counsellor may, if your father is willing to, review your dad’s life story. That may give your father the opportunity to go through the various note-worthy events in his life and, in the process, he may bring out his regrets. The counsellor may find out the things that he holds near his heart. At the appropriate time, the counsellor may help him to think about the reality and the advisability of accepting the inevitable. There is no guarantee that the counsellor will be successful. But we find time and again that we are able to help people in that kind of situation. Your father and you need to get to a palliative care team. If you, the family members need help to cope with the situation emotionally, you should not hesitate to ask for help from the palliative care team.

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