SINGAPORE: As an oncologist or cancer doctor, Dr Eileen Poon lives on the margins of grief daily; delivering bad news to patients, caring for them in the final stages and witnessing firsthand the pain of families preparing for and dealing with loss.
Few things surprise her – but when she first met Mr Afif Yusli, who had been diagnosed with an aggressive form of brain cancer and told he had no more than 24 months to live, she was struck by how calm he was.
The 27-year-old had been referred to Dr Poon's team at the National Cancer Centre Singapore (NCCS), which specifically looks after adolescents and young adult patients with the disease.
“These young patients will be facing an existential crisis as well as a lot of distress because at this age, they are not supposed to be dealing with life and death,” she said.
Yet, despite struggling with symptoms such as vision problems and difficulty finding words, Mr Afif never showed any frustration or despair during their interactions.
“He understood the severity of his condition and he was realistic … he's almost like an old soul,” said Dr Poon.
“I can't quite put a finger on it ... It's almost as if he understood that this is what was happening; that it’s a bad thing to have happened; and he wishes that it didn’t happen to him – but what could he do?”
She was especially touched by how much Mr Afif cared about others instead of himself.
“He has incredible strength … and even though he is the one that's unwell, he was very concerned about the impact his death would have on his family and basically wanted to live in the most untroublesome manner as possible.”
Mr Afif Yusli, 27, at his home on Nov 18, 2024. (Photo: CNA/ Ili Nadhirah Mansor)
For terminally ill patients like Mr Afif, palliative care is more than just making them as comfortable as possible, said Dr Poon.
“A lot of times, our cancer patients do feel like they have lost their voice, or that they have lost a sense of identity,” she said.
Hence the need to respect what's important to them and try to help fulfil their needs and goals - which could range from preserving fertility to delaying treatment in order to finish something they were doing.
That was the case for Mr Afif, who was initially reluctant to undergo surgery to remove a tumour, as he wanted to complete his last trimester in school.
He only changed his mind and decided to defer his studies when doctors found out his growth was not benign but cancerous.
Dr Poon also had a patient who had undergone multiple surgeries but whose tumour kept growing. She decided against a further biopsy so she could have enough strength to go travelling with her daughter.
“My job as an oncologist would have been ideally wanting her to get a lung tumour biopsy and get treatment," said Dr Poon. "But at the end of the day, she understood the implications.
“What's important to her is to be able to spend whatever time that's left in a meaningful manner. And this word ‘meaningful’ is not what's meaningful to me as an oncologist, but what's meaningful to her.”
Her team also helps with end-of-life matters such as where and how a patient wants to spend their final days, as well as legacy planning – deciding how to distribute assets after dying.
Doing so can help terminally ill patients and their families gradually come to terms, and it's not always about money that needs to be passed on, said Dr Poon.
She shared another example, this time of a man with aggressive brain cancer who prepared timed emails to be sent to his five-year-old son at different milestones in his future.
“He knew he didn’t have much time left because the tumours in his brain may potentially affect his thought process and his ability to think and express himself," she said.
"And he also needed a way to come to terms that he was going to die."
Counselling is also offered to caregivers of terminally ill patients, to help them process the emotional toll on them.
“If the caregivers do not understand and they get mistaken that we are giving up on the patient, then it can also lead to unnecessary stress to the patient,” said Dr Poon.
“That makes it difficult for the patient to come to terms; be at peace; and also, in time to come, have what we call a death with dignity.”
Mr Afif Yusli, 27, and his mother Rima Melati, 56, who stopped working to look after him. (Photo: CNA/Ili Nadhirah Mansor)
Mr Afif's latest scans showed that his condition was relatively stable for now, said Dr Poon.
While his prognosis remains in the realm of 18 to 24 months, this isn't definite, she added.
"It's been an open secret, really, that we are horrible at predicting prognosis ... the only time that we are highly accurate is when patients are immediately dying, meaning like perhaps they have just a few days left. In such times, we tend to be generally pretty correct," said Dr Poon.
"But in this kind of situation (where a patient's condition is not deteriorating rapidly) it's difficult to say, because sometimes miracles can happen ... and sometimes they do last longer than expected."
In the meantime, having put his film diploma course on hold to focus on cancer treatment, Mr Afif will resume studies in January and expects to graduate in April.
He also hopes to produce a film loosely based on his life, to raise awareness of and give hope to other young cancer patients.
But with time against him, a care coordinator at NCCS sought the help of charity Ambulance Wish Singapore (AWS), which fulfils the last wishes of terminally ill patients aged 19 and above.
It was an uncommon request as the organisation usually receives requests such as family photo shoots or celebrations, said Ms Elaine Chin, assistant manager of programmes and services at AWS.
But the 34-year-old has been moved by Mr Afif's positivity and is determined to help: She's currently waiting for him to finish his script before seeing how AWS can step in.
Mdm Vuda Venkatalakshmi, who passed away recently, celebrated her 79th birthday with her loved ones. (Photo: Jarrett Lee)
Ms Elaine Chin (left) helped to fulfil Mdm Vuda Venkatalakshmi's (right) last wish to have a birthday celebration with her family. (Photo: Jarrett Lee)
To demonstrate how AWS works to create experiences that "matter deeply" to the people they help, Ms Chin cited how her team put together what could be the last birthday party for a patient whose condition rendered her unable to talk or walk without difficulty.
On the day of the event, when the AWS team arrived to set up, they were shocked to see the woman bedridden and wearing an oxygen mask.
“We were quite worried for her because her condition didn’t look good,” said Ms Chin. “We weren’t sure if we were going to be able to go ahead with the party.”
But to their surprise, the 79-year-old proceeded to remove her mask and walk around the house with little assistance.
“With her wish of having her family together being fulfilled, and being surrounded by the love from people around her, she somehow found the strength to overcome her condition," said Ms Chin.
"Knowing that we managed to fulfil a person’s final wish brings some comfort to me, because we were able to do something for them in the final stages of their life – to help them be able to go, hopefully, without any regrets."
Read Part 1 of the series, on Afif dealing with dying young, here.
Part 2, on his mother coming to terms with her son possibly dying before her, is here.
Continue reading...
Few things surprise her – but when she first met Mr Afif Yusli, who had been diagnosed with an aggressive form of brain cancer and told he had no more than 24 months to live, she was struck by how calm he was.
The 27-year-old had been referred to Dr Poon's team at the National Cancer Centre Singapore (NCCS), which specifically looks after adolescents and young adult patients with the disease.
“These young patients will be facing an existential crisis as well as a lot of distress because at this age, they are not supposed to be dealing with life and death,” she said.
Yet, despite struggling with symptoms such as vision problems and difficulty finding words, Mr Afif never showed any frustration or despair during their interactions.
“He understood the severity of his condition and he was realistic … he's almost like an old soul,” said Dr Poon.
“I can't quite put a finger on it ... It's almost as if he understood that this is what was happening; that it’s a bad thing to have happened; and he wishes that it didn’t happen to him – but what could he do?”
She was especially touched by how much Mr Afif cared about others instead of himself.
“He has incredible strength … and even though he is the one that's unwell, he was very concerned about the impact his death would have on his family and basically wanted to live in the most untroublesome manner as possible.”
Mr Afif Yusli, 27, at his home on Nov 18, 2024. (Photo: CNA/ Ili Nadhirah Mansor)
WHAT IS MEANINGFUL, AND TO WHOM?
For terminally ill patients like Mr Afif, palliative care is more than just making them as comfortable as possible, said Dr Poon.
“A lot of times, our cancer patients do feel like they have lost their voice, or that they have lost a sense of identity,” she said.
Hence the need to respect what's important to them and try to help fulfil their needs and goals - which could range from preserving fertility to delaying treatment in order to finish something they were doing.
That was the case for Mr Afif, who was initially reluctant to undergo surgery to remove a tumour, as he wanted to complete his last trimester in school.
He only changed his mind and decided to defer his studies when doctors found out his growth was not benign but cancerous.
Related:
Dr Poon also had a patient who had undergone multiple surgeries but whose tumour kept growing. She decided against a further biopsy so she could have enough strength to go travelling with her daughter.
“My job as an oncologist would have been ideally wanting her to get a lung tumour biopsy and get treatment," said Dr Poon. "But at the end of the day, she understood the implications.
“What's important to her is to be able to spend whatever time that's left in a meaningful manner. And this word ‘meaningful’ is not what's meaningful to me as an oncologist, but what's meaningful to her.”
Her team also helps with end-of-life matters such as where and how a patient wants to spend their final days, as well as legacy planning – deciding how to distribute assets after dying.
Doing so can help terminally ill patients and their families gradually come to terms, and it's not always about money that needs to be passed on, said Dr Poon.
She shared another example, this time of a man with aggressive brain cancer who prepared timed emails to be sent to his five-year-old son at different milestones in his future.
“He knew he didn’t have much time left because the tumours in his brain may potentially affect his thought process and his ability to think and express himself," she said.
"And he also needed a way to come to terms that he was going to die."
Counselling is also offered to caregivers of terminally ill patients, to help them process the emotional toll on them.
“If the caregivers do not understand and they get mistaken that we are giving up on the patient, then it can also lead to unnecessary stress to the patient,” said Dr Poon.
“That makes it difficult for the patient to come to terms; be at peace; and also, in time to come, have what we call a death with dignity.”
Mr Afif Yusli, 27, and his mother Rima Melati, 56, who stopped working to look after him. (Photo: CNA/Ili Nadhirah Mansor)
CELEBRATING LIFE
Mr Afif's latest scans showed that his condition was relatively stable for now, said Dr Poon.
While his prognosis remains in the realm of 18 to 24 months, this isn't definite, she added.
"It's been an open secret, really, that we are horrible at predicting prognosis ... the only time that we are highly accurate is when patients are immediately dying, meaning like perhaps they have just a few days left. In such times, we tend to be generally pretty correct," said Dr Poon.
"But in this kind of situation (where a patient's condition is not deteriorating rapidly) it's difficult to say, because sometimes miracles can happen ... and sometimes they do last longer than expected."
Related:
In the meantime, having put his film diploma course on hold to focus on cancer treatment, Mr Afif will resume studies in January and expects to graduate in April.
He also hopes to produce a film loosely based on his life, to raise awareness of and give hope to other young cancer patients.
But with time against him, a care coordinator at NCCS sought the help of charity Ambulance Wish Singapore (AWS), which fulfils the last wishes of terminally ill patients aged 19 and above.
It was an uncommon request as the organisation usually receives requests such as family photo shoots or celebrations, said Ms Elaine Chin, assistant manager of programmes and services at AWS.
But the 34-year-old has been moved by Mr Afif's positivity and is determined to help: She's currently waiting for him to finish his script before seeing how AWS can step in.
Mdm Vuda Venkatalakshmi, who passed away recently, celebrated her 79th birthday with her loved ones. (Photo: Jarrett Lee)
Ms Elaine Chin (left) helped to fulfil Mdm Vuda Venkatalakshmi's (right) last wish to have a birthday celebration with her family. (Photo: Jarrett Lee)
To demonstrate how AWS works to create experiences that "matter deeply" to the people they help, Ms Chin cited how her team put together what could be the last birthday party for a patient whose condition rendered her unable to talk or walk without difficulty.
On the day of the event, when the AWS team arrived to set up, they were shocked to see the woman bedridden and wearing an oxygen mask.
“We were quite worried for her because her condition didn’t look good,” said Ms Chin. “We weren’t sure if we were going to be able to go ahead with the party.”
But to their surprise, the 79-year-old proceeded to remove her mask and walk around the house with little assistance.
“With her wish of having her family together being fulfilled, and being surrounded by the love from people around her, she somehow found the strength to overcome her condition," said Ms Chin.
"Knowing that we managed to fulfil a person’s final wish brings some comfort to me, because we were able to do something for them in the final stages of their life – to help them be able to go, hopefully, without any regrets."
Read Part 1 of the series, on Afif dealing with dying young, here.
Part 2, on his mother coming to terms with her son possibly dying before her, is here.
Continue reading...