City Lights Bulletin-palliative Care

Beyond Cure, Not Beyond Care If you have so much to live for but time is not on your side, what would you do? Patients of the The Medical City Cancer Center have to face this questions sooner rather than later. For them, the center has a palliative care program to help them deal with these critical issues. Dr. Liza Manalo and the team of specialists and speciallytrained paramedical staff provide patients with the best care possible—holistic, family-oriented, and multidisciplinary throughout their transition. Undoubtedly, dealing with cancer is enormously challenging for patients, families and medical practitioners, especially when prognosis is bleak.

The Palliative Care Team is specially trained to provide care at this arduous time. They give excellent medical treatment: curative, if necessary, and supportive, more importantly. They facilitate psychosocial care, counseling, family meetings, and spiritual care. They give terminal, grief and bereavement care. Families are assisted disclosure, caregiver issues and fatigue, as well as the different stages of grieving and resolution of family issues. In the end, the pain of loss is overcome and the beauty of life, family, and hope is highlighted.

She asked herself, “How can we help the patients die smiling?”

For in fact, terminal problems do arise. For instance, terminal delirium and death rattle (the gurgling sound that precedes the last breath) often drive the family to panic. Palliative care specialists can calm patients and their family and respond effectively to these situations. Doctor, patient, and family also discuss advance directives (i.e. DNR or do not resuscitate) should they reach the terminal stage. At the point in the patients’ life when others start to wrap things up, the palliative care practitioners do their best work. “We neither hasten nor delay death. We help patients and their families prepare for it. We take care of terminally ill patients up to the very end. Our patients go with an open heart, surrounded by loved ones, prepared to face what is ahead, and grateful to have lived.” This has not always been the case. During her formative years in medical school, Dr. Liza Manalo was heartbroken and indignant whenever she encountered patients who were dying and did not even realize it. She felt that she had to do something to change the situation. Patients have to know about their condition, learn to face their disease, and prepare for the end with their families. Someone has to be at bedside when they go. She would asked herself, “how can we help the patients die smiling?” This led the Family Medicine diplomate board placer to further specialize in Supportive, Palliative, and Hospice Care at the University of the Philippines-Philippine General Hospital (UP-PGH). She wanted to be able to respond effectively to the specific needs of the terminally ill patient and their family. She has certainly honed her clinical skills through training, practice, and continuing education. She further developed herself by successfully earning her Master of Science in Epidemiology from the UP Manila College of Public Health. She attended Seminar Sessions on Epidemiology and Biotechnology in Germany and Austria as a fellow as well. She is also on the Specialty Board of Examiners for the Philippine Academy of Family Physicians and is a contributor in the Epidemiology section of the PAFP textbook. But her heart is firmly ensconced in palliative care. A member of the International Association of Hospice and Palliative Care, she was awarded a grant to study cancer pain and teaching dying with dignity to medical students for presentation at the

10th Congress of the European Association of Palliative Care in Budapest, Hungary. Her interest in the area showed in her research activities on cancer, home care, counseling, and ethics. Dr. Liza Manalo has both the expertise and the heart for palliative care. And she wields both with every patient she encounters. She shares how every patient leaves a very pleasant memory—none of them sad— because in each patient’s story, “I find something beautiful. I was with them throughout the whole process.” She acknowledges that there are very good cancer centers abroad, but The Medical City Cancer Center offers the same quality of care, with the special touch of the Filipino. The Cancer Center is equipped with the necessary technology. Its doctors and paramedical staff are competent and specially trained in the area. What sets it apart is the lambing (affection), compassion, and hospitality that is characteristic of Filipino health care. In the center, the patients and families find themselves in the care of the kababayan (fellow countrymen) and kapamilya (family). At this difficult time, the TMC Cancer Center aims to provide them with multidisciplinary treatment and care as seamlessly as possible, with the patients’ wishes and well-being taken to heart. She recalls a recent case that warms her heart. The dying patient was in bed, surrounded by her entire family. Tubes and other paraphernalia attached to the patient had been removed. The whole family was singing hymns, holding hands, and praying. They literally held the patient in their arms as she died in their loving presence. All the stress and sacrifice dissipate when the patient and family approach Dr. Manalo and her fellow practitioners with gratefulness. At the deathbed for patients and at the wake for their families, they say, “Thank you for doing this with me.”