“Where To Draw A Line” By Dr. Madhuri

“Where To Draw A Line” ” presented on 8th Oct 2006 during the function “Diwali With a Purpose” by Dr. Madhuri – Medical Director

As an anesthesiologist I started my career 12 years ago with SATSEVA for a very gratifying professional work of cancer pain management. In the beginning when my patients pain continued unabated, I used to sit in loneliness and cry, which perhaps even my family members do not know.

The earnest cry for solutions yielded imaginative and creative thinking and I got a hold on pain and symptom control and how to manage them. Mere prescription of medicines and drugs do not mitigate pain. A compassionate care – giving time to hear the inner psyche of the patients’ problems helps mitigate sixty percent of the pain. Such hearing given to the patient in depressed moods, not only relieves the patient from the anxieties and inner burden; but also gives us a great learning. Some patients teach health professionals a great deal more than any text books or foreign courses can.

During this period of deep involvement with pain management, there are many issues, which have been haunting my mind. Today I would like to dwell upon a subject “where to draw a line”:

Medical culture often equates death with failure; the other way around, we attend failures of curative treatment.

Medicine is all about curing the disease. Ironically in modern medicine, it is disease and its treatment that assumes the foreground, while the physical pain and mental suffering of the patient is pushed to the background. Though pain is usually a useful warning symptom of some disease or damage, however, there are many different stages of disease where pain has no purpose or function and can cause untold misery to the sufferer. Chronic pain is one such variety. It is an affliction with immense suffering that erodes the tolerance and self-respect of the sufferer and grinds down the spirit.

A single-minded focus on cure compounded by society’s ambivalence towards death and dying has resulted in favour of treatment-oriented approaches regardless whether they improve patients’ quality of life.

In case of a patient with advanced and irreversible stage of cancer, there comes a time when despite our best efforts and all modern advances in medicine, caring family members have to reconcile that there is nothing more to offer the patient to control the disease by any means. Most families want “no stone unturned” for the patient, but the family members do not understand what it costs beyond a certain stage to turn each stone in terms of pain and suffering to the patient leaving aside the financial aspect.

Patients and their families are overwhelmingly appreciative when a skilled and sensitive doctor or a palliative care team offers comfort and dignity to patients facing their last days.

There are many gray areas overlapping active form of therapy and palliative care. Therefore when the disease reaches a stage of irreversible process, family physicians and the treating oncologists should consciously put in an effort to educate the patient and the family members on the pitfalls of treatment procedures and allow them to make an informed choice between the “quality of life” through palliation and the estimated remission in prolonging the “length of life” by resorting to further treatment.

When the disease, in particular cancer, reaches an irreversible stage, palliative care should take precedence over “cure at all costs” type of medical approach.

These unfortunate patients have lost their battle with cancer, but still are living human beings.

World Health Organisation advocates “Relief from Cancer pain merits consideration as a human right”.

I end with the hope that one day the family members, family physician and the treating oncologist respect the patients’ bill of rights.