Putting time on hold for final farewell
St. Mary’s Hospice serves terminal patients with distinction
By Noh Hyun-gi
A patient passed away as this reporter walked into the Hospice and Palliative Care Center at Seoul St. Mary’s Hospital, April 16. Across the corridor, it appeared rather uneventful for a hospital death; there was neither a rush of doctors nor a call for a Blue.”
“Sorry I am late. I was praying with the family. The patient left us a few days sooner than we expected,” apologized Sister Ra Jeong-ran, the general manager of the facility. Her team serves patients in final stages of cancer. “Oncologists refer patients to our center when they determine that further treatment is of no use.”
When asked what she told the mourning family, the nun with 14 years of medical experience emphasized that it’s more important to prepare oneself before the final moment.
“We encourage people to express their love, thanks and forgive one another. If these things are left unsaid, they haunt the survivors after the farewell.”
When a patient enrolls at the center, a team of physicians, nurses, social workers and nuns or priest consults him or her and caregivers to identify the need for communication.
Ra recalled a 19-year-old boy who came to St. Mary’s with a brain tumor. Though the patient had accepted his condition, his mother refused to process the reality and sought an invasive regimen.
After multiple meetings with the staff, she finally agreed that she gave her son everything she could and signed a DNR (do-not-resuscitate) order.
“The mother even let her son be baptized. She did not share the same belief but honored his will and perspective on death.”
In addition, a social worker recognized that the patient’s younger sister felt neglected by the parents during a home visit. So the center organized group therapy for the family members to focus on her experience with the brother’s illness.
This multi-pronged approach is a crucial part of palliative care which focuses on symptom management as well as psychological and spiritual assistance. The World Health Organization defines it as an “approach that improves the quality of life of patients and their family facing life-threatening illness.”
Ideally, people with a life expectancy of six months should take advantage of a hospice, but patients at St. Mary’s rarely survive past three. “Often diagnosis is delayed due to late screening and people prefer chemotherapy, radiation therapy and surgery even in stage 3 or stage 4 in Korea,” Ra explained.
Fortunately the number is growing. According to the Ministry of Health and Welfare and National Cancer Center, the number of patients benefiting from hospice services reached 80,000 last year compared to 13,000 in 2008.
Anyone suffering from a life threatening illness can receive palliative care. For now, the Korean government is targeting cancer patients. Since 2005, it has been accrediting hospice facilities and hosting workshops. In February, the bureau announced that it will support 44 care units (725 beds) with 2.3 billion won.
In 2013, the health ministry plans to expand insurance coverage. Patients at certain facilities including St. Mary’s can rely on national health insurance to reimburse part of their fees.
Despite her composure during the interview, watching patients part with the world takes its toll on her team. “Overseas, centers provide counseling programs for the staff and offer vacation days after a member assists with a certain number of deaths,” Ra said.
Such accommodation is a luxury. As the only independent hospice among Seoul’s “big five” (Asan Medical Center, Seoul Samsung Medical Center, Severance Hospital, Seoul National University Hospital and Seoul St. Mary’s Hospital), all 27 beds are always occupied and the waiting list is endless; patients coming from other hospitals may wait up to three weeks.
The situation is similar across the country. The health ministry estimates that Korea only has 29 percent of the necessary hospice supply (2,500 beds).
Though she may not see her patients walk out healthy, Ra is grateful for the humbling experience at the center.
“It makes my day when a patient tells me he slept like a baby for the first time in years. Here, we strive to make our patients comfortable in their final days. It is always rewarding to hear that I helped them find happiness.”