『比悲傷更悲傷的故事』Afterthoughts

『比悲傷更悲傷的故事』

First film of 2019. (Warning: Spoilers ahead)

Yet another tear-jerking film. Throughout the entire screening, I couldn’t help but felt really frustrated about how K tried to hide his terminal illness from Cream. At the same time, I was also very touched by his selfless and noble love. This show does offer a lot of room for thoughts and reflections about the issue of death and dying.

Having completed an internship in a hospice as a Medical Social Worker, I wondered how the entire film would have turned out if a MSW is involved? One thing that stood out to me was the collusion between K and his doctor – where they kept K’s diagnosis from Cream. Understandably, what K was trying to do was to protect Cream from further harm, sadness and to prevent her from feeling abandoned. K did not want Cream to relive her past experience of losing her loved ones.

Despite this entire show being a film, in real work with real people, the act of collusion between healthcare workers and patients/family members is actually common and prevalent. Family members do not want patients to know of their terminal illness/diagnosis for the fear of causing them distress/making them depress. This is somewhat similar to how K kept his diagnosis from Cream for the fear that Cream would not have been able to take it if she knows about his diagnosis.

“If a MSW is involved, what could have been done?”, I wondered to myself. Being someone who values honesty and truthfulness, I would have been tempted to disclose K’s diagnosis to Cream – so that they could spend their remaining time in a more fulfilling way and that K could have died a better and more meaningful death. At the same time, this also offers Cream a chance to break out from her past experience of traumatic loss of family members and seek closure in her relationship with K.

However, given a real-life situation, I believe that K would still have the final say. As a MSW, my role perhaps would have been to try to facilitate conversation and to allow K to understand the possible implications of his decisions. At the same time, to provide psychosocial support to Cream.

One of the key takeaways I had was that we will never know what is the best for another party (be it our loved ones or clients or anyone), just like how K was wrong to think that getting Cream to get married would have buffered the sadness from his death. Communication is always the key.

 

Photo taken from: https://mydramalist.info/title/48798/bi_bei_shang_geng_bei_shang_de_gu_shi

My experience as a medical social work student in the hospice (WK 1-4)

Woah, time flies and I have finally ended my 2.5 months of internship as a MSW in one of the hospices in Singapore. I think it is also a good time now for me to do a little reflection to help me consolidate some of my learning and detail some of my experiences so I will never forget them. 🙂

When I first entered the hospice, being an undergraduate who hasn’t been exposed to the medical setting, it was a completely new experience. I could still remember, on my first day, soon after I arrived for work, I was asked to join in the handover (meeting consisting of the doc, nurses and MSW – update the team on the patients). During the meeting, I felt slightly overwhelmed because, on top of the complexity of each cases, there were also so many medical terms that I had to grapple with.

Lesson Learnt:

• To be a self-directed learner and google all the medical terms that I don’t understand. 

During the first week, as my supervisor wasn’t around to guide me, I did my readings and spent a bulk of my time in the hospice befriending some of the patients. I was a little fearful at the start because I wasn’t sure if what I say would upset the patients, however, overtime, I realized that most of the patients are actually more than willing to engage and that they always have so many interesting life experiences to share. To be honest, I have learnt so much more from them than from the readings I did.

• Many times, what is hindering us from saying or doing something is the way we perceive things. If we never clarify or dare to try, we’ll never know how the patient feel. 
• Most patients are actually open to talking about death, sometimes it is our own fear and anxiety that hold us back. It is always good to reflect. 

In the same week, I also did some house visits with the doctors and nurses. All I can say is WOW I am very impressed by how good the nurses are in handling the patients and their wounds and how professional the doctors are in breaking prognosis. It was also during then that I saw how appreciative many families are towards the medical team, especially the nurses. There was such a strong rapport between the nurses and the family and I wondered what role does a MSW then play if the nurses could do, not just the wound and pain management, but also the psycho-emotional intervention.

• One thing that distinguishes MSW from the other profession is our knowledge and application of theories in our assessment as well as the soft skills that we have. It is therefore, very important to be well-equipped and strong in our theoretical practice. There is also a constant need for us to build up on our counselling and soft-skills.

In the second week, when my supervisor returned, I visited one of her patient who is in critical condition with her. I don’t think I was prepared for the kind of emotions that overwhelmed me. When I first saw the patient, part of me felt really sad that the person is about to die, another part of me was just really curious about how the patient feels. It was very touching to see how my supervisor constantly reassured the patient to not be afraid (even though the patient could no longer verbalise, but she could still nod her head) and to embrace whatever is to come. Afterwards, my supervisor also started praying with the patient by the bedside as the patient was a Buddhist and she used to pray regularly with my supervisor. The prayers really helped to calm and comfort the patient.

I almost teared up when I saw my supervisor pray with the patient. It is such a privilege to be able to be there for the patients towards the last days of their lives and also to be able to develop such a close and intimate relationship with them. Compared to my previous experience in an FSC, spirituality and religion is such a HUGEE part of palliative care. Many times, it is not just about the physical pain, but also the psychological, social and spiritual pain. Towards the end-of-life, medicine cannot treat, but the positive social rls and having a religion really provides some comfort

In the next few weeks, I got to tag along with different MSWs for their sessions and intake. It enhances my learning by allowing me to pick up the good things the respective MSW did during session. However, it also allowed me to see what are the kind of questioning techniques etc that I won’t ever want to pick up.

Through my observation, one thing that is rather common in the work of a hospice MSW is having to handle strong emotions of the patients and the family.

To cry with the patient& family? Or to not cry with them?

At first, I find myself restricting myself from crying. Then I started wondering, why? Why is it that I can’t allow myself to cry? Personally, I am someone who express myself very freely and I cry often because I find it very therapeutic for me. It was sometimes, really difficult for me to keep my tears in when I feel so much for the patient and their family.  Over time, I realized that it is important for medical personnel like us, to figure out and understand, “what is the meaning behind our tears?”. Are we crying for ourselves? For our own state/fear? Or are we crying because we truly empathize? Having the ability to feel can sometimes allow us to better connect with the patient/family that is grieving and allow us to build better rapport and trust. To me, it is okay to show the family the vulnerable side of us, because after all, we are humans too.

As my hospice was undergoing some renovation and I did not have much cases to do, I went around befriending some patients. I was so glad to have met this old, wise aunty who was always very enthusiastic to talk/play chess with me. She taught me a lot about life, her values and her beliefs. She gave me advice and sometimes even offered me food. There was once when I shook hands with her. She felt that my hands were cold so she wrapped my hands up in hers so she could warm me up. I only got to know her for a month or so before she eventually passed on.

It was the first time in my internship that I have felt such deep connection with a patient. When I went in to the lying in room to see her lifeless body, I really couldn’t help but tear up. My supervisor stood by me as I let all my emotions out. Part of me is grieving over the loss of such a great person, but another part of me is just glad that her suffering has come to an end.

— TBC —