There was the usual chatter at the family dinner table but my mind was somewhere else. The scene that kept replaying in my mind was what my patient said, as her son lifted the oxygen mask off her face. She muttered weakly in Cantonese: “Thank you for all that you have done for me these few years”.

As tears welled in my eyes, I quickly looked away and left the room. I didn’t want her family to see me cry.
After all, earlier that afternoon, I asked the family members to try their best not to cry in front of her.

As the whole family gathered by her bedside, we all knew that the end was near. She was admitted to hospital two days earlier for profuse bleeding, pain and weakness.

When I saw her, she looked as pale as if there was no more blood in her. We transfused bag after bag of blood and blood products to try to halt the bleeding.

I called the liver surgeon to see if he would consider emergency surgery to try to stop the bleeding. He said that if he operated, there was a high likelihood that she would die on the operating table.

That afternoon, the pain was suddenly worse and I went up to the ward to see her as quickly as I could. I put up an intravenous morphine infusion and liberally pushed in the medicine to dope her. Within minutes, her groaning stopped and she quietened down.

I had promised her that I will not let her suffer.

I have been looking after Madam Chau since January 2010 when she was diagnosed to have primary liver cancer, which had already spread into the blood vessels and to the spine.

She initially saw a general practitioner for back pain. Through routine blood tests, she was discovered to be a hepatitis B carrier. She could not recall when she had been exposed to the virus and was unaware that she had been harbouring the virus.

Within a week of seeing her GP, she came to see me and asked me to handle her illness. Although she was only six years older than me, I have been calling her “auntie” from the beginning.

This habit of mine to refer to patients above 40 years of age as “uncle” or “auntie” has been with me since I was a young doctor. I have steadfastly refused to adjust for the fact that I am already in my mid-50s.
For four and a half years, I have been seeing Madam Chau almost once every month.

With initial treatment, we managed to bring her cancer markers down to the normal range. With Stage 4 disease, we were both aware that it was merely a reprieve and not a full pardon.

Auntie and I got along well together. I suspect that one of the reasons was that she spoke perfect Cantonese. After all, she was born in Hong Kong but moved to Singapore more than 30 years ago. Although I am a Hokkien, the only dialect that I can speak reasonably well is Cantonese, which my mother and my caretakers taught me.

I can understand how dialects help to bond people closer together. It made me feel particularly close to auntie.

We used to talk about the latest Hong Kong serials, the food that we liked to eat and her faith in Christ.
She knew that I liked to eat braised chicken feet (which in Cantonese, we more elegantly refer to as “phoenix claw”) from a particular restaurant in Shenzhen.

Whenever she visited Hong Kong, she would buy this delicacy and deliver it to Mount Elizabeth Emergency Room. Her daughter would then call me through the doctor’s hotline to tell me that “the package had arrived”.

As the years went by, she knew that she did not have much time left. She would drop subtle hints like “I know you have tried your best”, “You don’t need to try too hard”, and “This may be the last visit to see my family in Hong Kong”.

When the end came, it was swift and painless. I was with her as the blood pressure drifted down and her heart rate slowed.

I muttered “goodbye auntie” as I quickly walked away before her children could see me tear.

Patients’ death takes a toll on all doctors, although we do our best not to let our emotions show.

Before my mum died, I used to jokingly tell her that I have seen death so often that I would not shed a tear at her funeral. The standing joke among my family, friends and staff is that they all saw me wail like a baby when mum passed away.

This has been a particularly difficult month because two “aunties” died. Madam Chau whom I have cared for about five years, and another patient whom I had looked after for 20 years.

In medicine, pain has a special significance. We evoke pain in unresponsive patients to check that they can feel and respond appropriately to noxious stimuli.

It is not professional for doctors to cry when a patient dies. But for me, this pain has a special significance – it attests that I can still feel the loss of those I cared for.

Written by Dr Ang Peng Tiam

Tags: cancer doctor stories, stage 4 cancer