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Helping a Terminal Patient Live with Comfort and Peace

As a palliative care nurse, Jacqueline Khoo made painstaking efforts to help her terminal patient, Madam Tan, live a quality life with peace and comfort in her remaining days during the last stage of her life.

SG20190505 MEA PRP 024Tzu Chi’s nurse, Jacqueline Khoo (in the middle) and volunteer, Lee Oi Heng (first from the left) visiting Madam Tan at her home to clean and dress her wounds.

In a one-bedroom HDB flat, lived an old couple with their maid. The small unit, which was less than 300 square feet, was occupied by two single beds, an electric homecare bed, an oxygen machine, countless packets of adult diapers and other items used by an elderly, bed-bound patient. Thus, there was very limited space for the occupants or visitors to move about. 

The patient was 80-year-old Madam Tan Kim Hoi, who suffered from Parkinson’s and Alzheimer’s disease as well as high blood pressure. Having been bedridden for a long time, a bedsore had grown in Tan’s backside, and she also had ischemia and necrosis as a result. Due to poor blood circulation, she had serious ulceration and gangrene in her right foot.

Madam Tan started receiving Tzu Chi Home Care Services in 2016. When her condition turned irreversible in 2019, she was referred to Tzu Chi’s Palliative Care team in April after receiving medical treatment at a hospital.

On 3rd May 2019, Tzu Chi Home Care Services nurse, Jacqueline Khoo, arrived at Madam Tan’s home, accompanied by volunteer Lee Oi Heng. They were there to help Madam Tan change the dressing of her wounds, take her body temperature, etc. Madam Tan was lying in her bed and appeared unconscious. From time to time, she would let out weak groans.

Before she started treating her wounds, Jacqueline used her mobile phone to play a Buddhist chant, and the soft music permeated the small flat. Subsequently, the maid, who had been taking care of the two old folks at home, slowly turned the body of Madam Tan to a sideways posture to allow Jacqueline to treat and clean her bedsore.

Upon removing Madam Tan’s top, a bedsore the size of a fist could be seen on her back and the surrounding skin colour appeared bruised. Wearing a mask and a pair of gloves, Jacqueline began cleaning the wound with saline and removing the necrotic tissues of the sore. Lee patiently waited at the side and assisted Jacqueline whenever she needed help, by passing over medical supplies, adjusting Madam Tan’s body, etc.

“Sometimes when you cut your finger by accident, you’ll feel very painful even though it is just a minor wound, what’s more, a bedsore this big,” remarked Lee.

Lee learned to count her blessings after witnessing how Madam Tan suffered. Each time she saw the agony on the face of a patient, she would feel grateful to have a healthy body and be able to care for the sick in the community.

A mini Buddha Bathing Ceremony of love and blessings

As the condition of Madam Tan’s bedsore and wounds in her right foot further deteriorated, the thrice-weekly home visits became daily, so that Jacqueline could treat and dress the festering wounds.

"We have to take care of her wounds. If we don’t treat the wounds, they will continue to fester and she will be in pain," said Jacqueline.

Although she knew that Madam Tan could never recover from her illness, and that her conditions would only continue to worsen, Jacqueline still did her best to attend to her wounds. She did not wish to see Madam Tan lying in her bed with worms wriggling on her, so she never forgot to ask the maid to keep an eye on the condition of the wounds. If the maid discovered any worms on Madam Tan, she must immediately inform Jacqueline.

As a nurse, Jacqueline opined that her role was to keep her patients as clean and comfortable as possible, help relieve the symptoms of their illnesses and their pain, and improve their quality of life.

"The final stage of life can be comfortable. The patients can eat whatever they like to eat just like normal people, and spend their remaining days with their family," shared Jacqueline.

On 28th April 2019, a mini Buddha Bathing Ceremony was arranged by the Home Care Services team and Tzu Chi volunteers at Madam Tan’s home. Jacqueline revealed that when Madam Tan was in a better state of health, she had agreed to have a mini Buddha Bathing Ceremony held at her home. She also said that since the elderly patient could not leave her home, then they would “bring the Buddha” to her home.

A beautiful lucite Buddha statue, a bowl of fragrant water, and magnolia flowers were used to set up a temporary Buddha Bathing altar in Madam Tan’s home. The small one-room flat was more crowded than usual on that day, however, the Buddha Bathing Ceremony was not affected by the space constraint at all.

After the volunteers were done making offerings to the Buddha, another Tzu Chi Home Care Services nurse, Lim Kim Yan, explained to Madam Tan’s husband, Mr Tang, the meaning and purpose of a Buddha Bathing Ceremony. They also demonstrated to him the three steps of the ritual, namely, “Bow to the Buddha, take a fragrant flower, and receive blessings.”

The quiet and reserved Mr. Tang put his palms together and prayed piously to the Buddha, completing the simple ritual with the guidance of the volunteers. Then, the volunteers carried the lucite Buddha statue, the glass bowl filled with fragrant water and the flowers to Madam Tan, to allow her to perform the same ritual.

In the spirit of “reaching out to the sick who are unable to walk out of their homes”,  the Tzu Chi medical staff visited Madam Tan at her home every day to give her care and to provide treatment for her. Their painstaking efforts had helped ease Madam Tan’s pain and discomfort while also giving a peace of mind to her family.

The simple Buddha Bathing Ceremony had also given the elderly couple an opportunity to receive the Buddha’s grace and the love and blessings of the volunteers.

Note: Madam Tan passed away peacefully on 23rd May 2019.

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