Advocacy

Reflection

“Masakit doc. Sinisisi ako ni Papa. Akala niya ay pinapabayaan ko siya”. Our patient’s daughter could not anymore hold back

the tears while in conversation with me and my consultant.

She was overwhelmed with the situation where they have no control. The hospital protocols are aimed to prevent SARS CoV-2 transmission and it means not being able to visit her father. A contrast to the culture we Filipinos were brought up into where family takes care of their own. She describes the pain of how her father who was in need of self-care assistance was placed in a ward for 3 days without any familial caregiver while awaiting for RT-PCR results. That three days of isolation

changed her father’s demeanor towards her.

It was a warm afternoon and wearing PPE made it absolutely boiling. Fog was condensing on my face shield and I could see the sweat drip from the edge of it. My eye glasses doing its own fogging was not helping the situation. We still had to adhere

to social distancing which made the palliative medicine approach feel somewhat disconnected.

This COVID-19 pandemic re-structured healthcare practice: face - to - face consultation was replaced by telemedicine, closure of out-patient departments, strict priority screening of entry to ERs, rationing of PPEs, managing an infection with no known treatment and healthcare worker discrimination. These times challenged the core of medical practice, and even more

so in Hospice and Palliative Medicine.

I am a family and community medicine resident. It has been nearly six months since we last applied our community practice due to border restrictions and community transmission concerns, our rotations were compromised and our training likewise, had certain limitations. This awakening also included building up a system of telemedicine which was the need of the hour

and going through the struggle of our very own infected with COVID-19.

The hospital had to activate a contingency plan which included the first out-of- hospital base COVID-19 treatment center managing moderate cases. The treatment center is to be managed by Family Medicine department. The tour of duty required us to stay in for 2 weeks without returning to our homes. While I was there, an IM colleague called me up with a concern for a family member in need of counselling. She narrated that her uncle was in deep grief due to the loss of a loved one as a result of COVID-19. As everyone assigned in the treatment center, I was also experiencing the constraints and struggles of being

part of a pioneer team. Included with that constraints as did impacted my emotional detail.

Her phone call caught me in the middle of a SMS patient update marathon and the thought entered my subconscious: Out of all the available services in the hospital, she chose to refer to SHP service. She trusted the specialty. Some identify palliative care clinicians are the specialists who can help make dreadful situations a little bit better, their medication prescribed can

provide relief and their words can deliver comfort.

What I did next burdened me. I had to refer the case to someone else as I reflected: How can I attend to a patient’s emotions when I still have to attend to mine and my team?. Palliative Medicine has taught me to first acknowledge and attend to

emotions and I was thankful for that learning. Emotion can disturb cognition.

Attached to our profession is the expectation to have the the appropriate level of thought and consideration. At that moment, I decided what was best for this patient and the best was not me to handle this case (at that time). This pandemic taught us that we are humans and we all have our own stress threshold. Personally, it was the disrupted and ever-changing work schedule,

separation from family, and the dread of infection. Who would ever thought that that physicians would be a vulnerable group?

Patient accessibility to essential drugs was another distress and home visits ranged from difficult to impossible.

Even in this pandemic, palliative care is still essential: manage symptoms for instance, shortness of breath and pain especially to those apporaching end of life, counselling patients and their families on how they might reach crucial medical decisions they need, or might need, to make. The meaningful role of SHP is to hear stories and accompany the family in their grief and fear. In this uncertain times, we shall persist to make appropriate adjustments, stepping outside our comfort zones and prepare for new experiences for the new reality we currently live in. All this to reach the goal of upholding the continuity of

holistic palliative care.

Faye Angeli Lomocso, MDChief Resident, Vicente Sotto Memorial Medical Center - Family and Community Medicine