IAmGoingHome

[Carbon82]

A good option for patients who wish to pass away at home. Kudos to Dr. Tan and the medical team at NTFGH.

If the option was presented to us during the last days of my late dad, we would have opt for it. 

Leaving ICU to die at home, surrounded by family and familiar comforts

Mr Hong Kaw was never comfortable whenever he was in hospital and would hanker to go home.

“Although my father was weak, he was still lucid. But on Nov 4, he could not be woken up from his nap and was rushed by ambulance to the hospital. We rushed down when we were told that his heart had stopped, but they managed to resuscitate him by using CPR (cardiopulmonary resuscitation),” said his daughter Hong Poh Ngor, 46.

Wanting to give her father a fighting chance and “fulfil whatever his wishes were in the time he had left”, she and her two siblings decided to have him treated at the intensive care unit (ICU).

When the family realised that the miracle they were hoping for – that he would regain consciousness – was not coming, they decided to fulfil his wish to die in his favourite recliner chair at home.

“After two days and with still no response from my father, we decided to have him brought home,” said Ms Hong, a treasury executive.

Mr Hong became the first critically ill patient from the ICU at Ng Teng Fong General Hospital (NTFGH) allowed to fulfil his wish to die at home. Within 1½ hours of reaching home, he died in his recliner chair, surrounded by family. He was 83.

Called IAmGoingHome, the project was started in October 2022 by medical teams from both the ICU and Supportive Care and Palliative Medicine at the hospital. Six other patients have since taken the same route as Mr Hong, and the hospital wants to make this a norm in the future. 

NTFGH is the first and currently only hospital to offer a structured initiative for adults.

“Letting go of such aggressive treatment is sometimes the best choice,” said Dr Tan Chee Keat, a senior consultant at the Department of Intensive Care Medicine at NTFGH.

“Even before (the) Covid-19 (pandemic), some of our patients expressed the desire to go home. They don’t want the loneliness of dying in ICU with all the machines around, but the logistics is tough because these people are on life support. We need to ensure their transfer back home is a smooth one,” she said.

She mooted the idea after a young patient who wanted to go home could not and died in the ICU in 2021.

Recalling the incident with tears, Dr Tan said: “This young man suffered late-stage eye cancer. He was in great pain and wanted to spend time at home before he died.

“His parents also wanted that for him but, at that point in time, we didn’t really know how to make the arrangements. The logistics floored us, and we could not help fulfil his wish.”

Initial challenges for the team included the question of whether life support should be terminated, as the patient may die “quite quickly” when intensive care treatment is stepped down for the journey home.

“Here, it has become more of palliative care, where some of the tubes have been removed and the patient is given oxygen to help with the breathing and medication to manage the pain – everything in small doses,” Dr Tan said.

In the last four to five years, NTFGH had an average of 150 ICU deaths annually. 

[Blueray]

few years ago my late aunt was diagnosed with dementia and cancer, the outcome was very clear, just a matter of time.

family decided to let her spend her remaining years at home and she passed away peacefully at home. 

to old folks, being at home is a big deal I reckon, and in their view, probably better way of going. 

[Abracadabra]

My late mother-in-law was terminally ill and was transferred from hospital to hospice during her last days. She had insisted on going home but never got to fulfil her wish. She passed away with a hospice nurse beside her and I felt sad we never get to see her during her last moments. 😢

[Playtime]

But not every home can handle a terminal patient. 

That requires 24hour attention,  not to mention any additional medical equipment etc.

[Sosaria]

On 5/3/2023 at 10:29 PM, Playtime said:

But not every home can handle a terminal patient. 

That requires 24hour attention,  not to mention any additional medical equipment etc.

That's why it's a bit like euthanasia, if you ask me, when I read that article.

Bring them home, they are not expected to live long. But the intention and purpose is for them to die at home.

[kobayashiGT]

This is a nice gesture for a closure. 🙏

[Playtime]

On 5/3/2023 at 11:29 PM, Sosaria said:

That's why it's a bit like euthanasia, if you ask me, when I read that article.

Bring them home, they are not expected to live long. But the intention and purpose is for them to die at home.

actually thats exactly what i tot, but i dont think it is bad.

but i understand some may even find it very offensive. but the wishes of family, medical staff, and most importantly  patient probably will often not meet. 🤦‍♂️

with more and more single child family. and its practically a must now for both husband and wife to work. a bigger related problem now is not just having a dying patient at home.... maybe thats a 1 week thing???

the killer is having a long term invalid patient that last years. ugly topic... but real.

 

 

[Arogab]

Birth, Growing Old, Get sick and Death......Part and parcel of life. We just have to take it and move on. 

It's good to not hold on too much and just like this, die at home is a good thing

[PSP415]

Technically, without life support, these will die quite fast, within hours. 

A terminally ill/dying patient's last wish to die at home, in the presence of loved ones, in a familiar environment, filled with memories is actually an act of love, to me. 

He/she is not living a quality life, a prisoner in a very sick body and not in a hurry to go anywhere, just waiting for death.

Perhaps, the fear of death is not that frightening or resigned to it, hence, to just leave is a welcoming relief. 

Life oftentimes is not always about right or wrong to a dying person. It is a last wish, how many can have the option to decide where to die? Some meet death in an accident, some killed and most dun know its their last day on earth. 

Stay safe all 

 

[Spidey10]

On 5/4/2023 at 11:26 AM, Arogab said:

Birth, Growing Old, Get sick and Death......Part and parcel of life. We just have to take it and move on. 

It's good to not hold on too much and just like this, die at home is a good thing

how much we eat, how much we wear....is all fated! come what may...cycle of life...birth, marriage, children, death....a cycle where we cannot run away....a universal cycle.

i think when we learn to embrace this...we learn not to fear...

i was telling my wife, when we go, dun forget to bring along our watch so that we know what time to have tea when we are on the other side....

also told my kids to keep track of time in their own life...

Edited May 4, 2023 by Spidey10

[Arogab]

On 5/4/2023 at 10:54 AM, Spidey10 said:

how much we eat, how much we wear....is all fated! come what may...cycle of life...birth, marriage, children, death....a cycle where we cannot run away....a universal cycle.

i think when we learn to embrace this...we learn not to fear...

i was telling my wife, when we go, dun forget to bring along our watch so that we know what time to have tea when we are on the other side....

also told my kids to keep track of time in their own life...

I always tell my friends, if tomorrow I am no longer around. Don't miss me, cos you all have the best of me. And for me, I have not regrets. I have done any things in my life well and there will be no regrets when I am gone

And I tell my daughter, I have done my best for you. So, you should be doing your best and the rest is on you.

[Jellandross]

When my time comes, my wish is to say goodnight to my family like any other day, then lie comfortably on my own bed and go peacefully without drama 🙏🏼🙏🏼🙏🏼

[Playtime]

On 5/4/2023 at 12:57 PM, Jellandross said:

When my time comes, my wish is to say goodnight to my family like any other day, then lie comfortably on my own bed and go peacefully without drama 🙏🏼🙏🏼🙏🏼

We should be so lucky to have that. 👍

[Mustank]

Some day my turn will come 

 

[Mustank]

 

[Carbon82]

Somehow when a person get older, they tends to spend more at home and wish to "go" at home too. That was what I have gathered from my own relatives and friends with seniors at home. Unfortunately both my grandparents and my dad all passed away while at hospital, and so this article caught my attention immediately and how I wish the option was available for us previously. Luckily for me, I was with my dad when he had his last breath, else... 

For this scheme, I believe the medical team have carried out the necessary assessment and likely the chosen patients were those who cannot stay beyond a couple of hours after leaving ICU / hospital. Manpower shall be the primary concerns since medical staffs are currently still a scare resources, so unlikely that such scheme will become a norm in near term.

[Atonchia]

But dying at home meant must get Dr to certified the death? 

If PH and it's a long weekend, cannot leave the deceased stay there for 3 day right?

So called must call undertaker 1st and ask them to arrange for doctor to certify? 

 

Edited May 4, 2023 by Atonchia

[TangoCharlie]

This service was available in 2014 when my dad was in SGH. Basically there was nothing much the hospital can do in terms of treatment. Prolong life/death can, with medical advances but dad will remain comatose. And we know dad wants to be home.  Family had a meeting with the doctor in charge prior to terminal discharge. Need some coordination among hospital,  hospice and family for the home to be ready. luckily hospice able to provided the hospital grade bed, mattress and oxygen. Hospice doctor will take over the care of dad after the transfer and there is a number to reach him 24/7. We engaged pte nurses each pulling 12 hour shifts to make sure dad is as comfortable as possible.

Though the doctor did warn us dad may well pass away during transit, he stayed with us for 3 days.  No regrets, all of us have our private moments with him and saying our goodbyes. I believe he had not lost his sense of hearing despite being comatose. He passed away peacefully. We are at peace too.