Saturday, 16 August 2014

The day I wanted my father to die

It is abhorrent to contemplate the death of one's parents, yet we have to do that, at some point. Talking about end-of-life issues is an essential part of preparing for that eventuality.
By Chong Siow Ann, Published The Straits Times, 15 Aug 2014

SHORTLY after World War II ended, my father joined the multitudes of Chinese in the exodus from their country of birth to seek a better life for themselves and to enable those they left behind to have a better life. His passage to Singapore was arranged by an uncle who was the principal of a Chinese school here and wanted his help in running it.

Possessing the equivalent of a high school education, he was put to work almost immediately by the uncle, initially doing a bit of teaching and subsequently doing the accounts and keeping the books. He stayed in that school until he retired. In that time, he married and fathered five children.

One day every month, he would send money to his mother and siblings in China. With his modest salary, and the responsibility of looking after two families, my father was necessarily frugal. But he allowed himself a single indulgence - cigarettes.

Reserved by nature, he was also restrained in his expression of any overt emotion. His love was shown rather than verbalised. When any of the children fell ill, he would keep a bedside vigil through the night: sponging down a fever, soothing us.

In my first year of secondary school, he would turn up every evening at my school. He would commandeer my school bag and slip the strap on his shoulder, and we would make our way to the bus stop. Trudging alongside him and resentful with embarrassment, I would keep my eyes down - to avoid whatever derision and sniggers I imagined might come from my schoolmates - and shove my fists in my pockets to prevent him from taking my hand.

When he was in his 60s, he developed chronic obstructive pulmonary disease, probably from his years of smoking. The illness worsened, robbing him of his vitality, strength and eventually his independence. When I graduated from medical school, he could not make it to the convocation ceremony.

There were the weary and soul-sapping rounds of medical consultations and hospitalisations which became more and more frequent, each time leaving him even more debilitated. The slightest exertion would leave him winded and at times gasping for breath. It was painful, terrible and frightening to see.

Hidden thought

ON THE eve of Chinese New Year in 1995, my father was again admitted to hospital. Over the next few hours, his condition declined so precipitously that he had to be intubated and moved to the intensive care unit to be supported by a ventilator. Though sedated, he was still conscious but could not talk because of the breathing tube down his windpipe. His arms were restrained to prevent the intravenous lines from being dislodged. He had a feeding tube inserted through his nostril and a catheter draining urine from his bladder.

We kept a vigil outside the ICU, taking turns on and off to see him. On the afternoon of the third day, I was by his bedside and had his hand in mine. I could not find any words to say to him. He looked at me, moved his head, winced and tried to say something.

It was then that I wanted him to die. That thought must have been lying in my subconscious for some time like a hidden assassin waiting to strike.

Over the course of the next few days, I pleaded with him in my mind to let go and not fight any more.

In a piece in The New York Times on May 9, Japanese writer Minae Mizumura wrote of her exhaustion in looking after her ailing mother who had dementia. "Day after day, I sat by her bedside, exhausted," she wrote.

"'Mum, when are you ever going to die?'"

"To wish for the death of one's mother is universally taboo. Yet technological advances that extend life have driven us to the point where we do just that," she continued.

"To admit that one wishes one's mother would die; to forgive oneself for the wish; and to go on trying as best one can to make her happy to her dying day - is this not a true expression of love? For how can anyone riddled with guilt, thinking the unthinkable, find the courage to continue down a seemingly endless road?"

In the subsequent online discussion, many readers admitted having expressed similar thoughts. But there were also differing views. One found the article "selfish and mean", another decried "the lack of love towards one's own mother" and that it was "emblematic of modern culture which is so fascinated by convenience".

Over the next few days, with his lungs getting stiffer and the ventilator already at a high setting (which could burst holes in his lungs at any time), my father's kidneys failed, and he started bleeding from multiple sites and his blood pressure plummeted. Still the doctors persisted. They propped up his blood pressure with drugs and transfused packs of blood products which did not staunch the bleeding. The senior physician took me aside and said that they could give more blood products.

He was a kindly man who clearly did not want to say what both of us had known for some time. Nor did he say what he doubtlessly had thought would be the right thing to do. I went out and huddled with the rest of my family. Then I went back and told the physician to stop. Later that day, my father died.

End-of-life issues

I DID not think it was a lack of love that I wanted my father to die. It was quite the contrary. It was unbearable for me (and for my mother and siblings) to see him suffer - if anything, that was the selfish part of wanting to stop that pain inside me. I feel many things about my father's death but not guilt. I like to think that my father knew all those heroic efforts were staving off death only briefly and at a terrible cost of suffering to him.

But at the end of the day, I really do not know. I did not have that conversation about what is now called "end-of-life" issues when he was still mentally capable. I had thought of broaching it during his previous hospitalisations, but baulked each time. Imbued with that sense of filial piety, it seemed particularly abhorrent to even contemplate the death of one's parents.

Talking about end-of-life issues in the abstract is different from having to initiate that difficult discussion with someone you care deeply for, with all the attendant fears of causing distress, offence and misunderstanding. When people ask me how best to have this delicate discussion, I'm afraid I don't have any good advice.

However, I do tell them that I have signed my Advance Medical Directive - that legal document specifying that should I become terminally ill and unconscious, I would not want any medical treatment to prolong my already ebbing life.

That is at least something I can do for myself and to spare my family the anguish of making wrenching decisions.

It will also avoid any protracted and unnecessary medical treatment that could be financially ruinous for them.

"Death hath a thousand doors to let out life: I shall find one," wrote the English dramatist Philip Massinger.

The path that leads to our death might be beyond our control, but we might be able to choose to avoid a futile, messy and violent end.

The writer is vice-chairman on the medical board (research) at the Institute of Mental Health.

Heed call for public debate on assisted dying

IN HIS commentary ("The day I wanted my father to die"; last Friday), Associate Professor Chong Siow Ann shared his experience in dealing with his dying parent.

In doing so, he has given a valuable lesson to the children of elderly parents who may one day have to make similarly painful decisions.

Like Prof Chong, I have signed the Advance Medical Directive. I have also discussed end-of-life issues with my sons frankly and freely, and prepared them to make tough decisions.

But I would like to do more than that.

I would like a system that can guarantee me the right to a peaceful death and lighten the burden of decision-making for my children.

According to The Economist, two-thirds of Americans and Western Europeans support making assisted suicide legal.

We should debate whether Singapore should join the nations that have made death with dignity legal.

In his lecture at the Singapore Medical Association last year, Chief Justice Sundaresh Menon said assisted suicide "should continue to be a matter of public debate, private conversations with our loved ones and personal reflection" ("Assisted dying: A matter of life and death"; March 24, 2013).

Public debate in Singapore on this vital issue is anything but mute.

V. Navaratnam
ST Forum, 20 Aug 2014


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