Palliative medicine

 Iam a part time consultant in Palliative medicine 

( I prefer this label than Palliative care as today its diluted by volunteerism and tender loving care alone at times with medicine becoming a poor second ) .

There are many who can do TLC and good too it is so , specially in Kerala where most know about it and are willing to be part of it which is appreciable .

But to me with more than two or more decades in Onco hematology in India and abroad and my passion in chronic pain management specially in onco Palliative medicine ,  I want to focus on my skills and experience to be useful to my patients .

Though I go to Indira Gandhi Cooperative Hospital only three days a week ( I wanted it so at this time of my career ) 

 I look forwards to what I can do in those three days .

I still am in the benign shadow of a great physician  Dr VP Gangadharan Sir reknowned  medical onco hematologist and one who mentored me though now am  indepently in my speciality .

I can still walk over to his chamber to get his suggestions on patients of his and others .

To me a day in OP though not as busy as other leading consultants of the hospital is full and intresting .

I start off with my rounds of say 3 or 4 or 6 patients poring over thier files .

To me the diagnosis management complications in the file or EMR is easy to grasp by second nature and I can deduce what next for the patients well being for a best qaulity of life with  least expense .

My communication skills honed by time and study is useful to make them and family face the truth .

I use it to bring down anxiety and explain with honesty whats to be known .

Though often in my field disease progression is a reality the armamentarium I have in these times of referral to other specialists for palliative  Radiation at times surgery or palliative chemo or interventional pain management physio or occupational therapy to help in my aim of holistic well being of patient  using latest tech but only useful ones at least cost  .

Financial toxicity is a reality too .

As my field is low cost I use tests sparingly but dont shirk from using it when needed .

let me give some examples .

The Rotary club central Cochin has a scheme to help palliative dept in our hospital .

Apart from the ward they built they also reimburse cost of Fentanyl patches a costly pain reliving narcotic opioid .

This is great help to my patients who need it but cant afford it .

Yesterday I got a happy message from H ....with metastatic renal carcinoma that he just got all his Fentanyl bills reimbursed .

This has been going  on for last 3 years thanks to VPG Sir who was instrumental to its start and Vinu the points person involved in its sanction .

I also advise patients in need to get corporate help and in the many schemes of Govt specially the one by the  center the above  70 years senior citizens  PM Abay scheme of insurance upto 5 lakhs for all senior citizens of any îcome which includes pre existing diseases too .

Kerala never publicises such useful  central schemes .

its all politics

I dont know how selfishness can make people deny to the needy !

I tell families to apply to MP s health grants and avail railway and now KSRTC concessions .

My years of being a part of a NGO in my late daughters name has made me well versed to know the schemes available by our state itself .

Cochin cancer society of which am a part does so much like free stay in Snehaganga its resident  complex in Ernakulam for temporary treatment purposes where admission to hospital is not needed .

At times the happiness that comes from the relief of pain and other symptoms  of patients on admission or as outpatient is the best reward for me .

A 14 year old Nasopharyngeal carcinoma with blinding headache and facial pain smiling and  telling me after I saw her previous day

 Dr  I slept well last night 

makes me the happiest man on that day .

 I know once she is completes her treatment she would do much better .

But same could not be said of many of my patients now or in past.

I have fond memories of smiling and crying children of many ages and adults too over time .

Recently We just convinced a 80 year old colon malignancy patient whose family was not for any active treatment initially to get it investigated and finding she had an early stage malignancy with possible complete cure they agreed for surgery done sucessfully and well .

This is where oncology knowledge gives one an edge .

This is the advantage of working in a hospital with excellent  consultants in all fields so we can function as a team for the best of patient .

To me the 70 year old tall lanky advanced lung malignancy is a familiar figure last three years where I have been managing his pain as his cancer raced to his nerve plexuses and bones and we gave him radiotherapy , nerve blocks, chemotherapy ,and all possible pain medications 

He still smiles at me though now emaciated and terminal and I know his time is short .

Or the child I saw recently with an unfortunate sof tissue sarcoma occupying all her pelvis with so much pain she could only sit as lying down was painful .

We could to a small extent releive her with  opiods plus other analgesics , special cushions to spare pressure on her gluteal region though her disease is inoperable by extent and radioresistant sadly .

Many more such  experiences I can put here .

At times like this I do get annoyed with the power above harming such innocents while sparing the devils among us .

My speciality is humbling satisfying and fills me with gratitude .

To me a smile from my sufferers is the Oscar award I would never  recieve and am happy Iam a Palliative medicine consultant .

with every day an awakening .