WHEN doctors can do no more, palliative nurse Sim Lai Kiow takes over, providing comfort to patients close to death who have no family or friends of their own.
'Everyone celebrates a birth. When a baby is born, he is not alone. So even in the worst circumstances, no one should die alone,' said Ms Sim, 51.
From time to time, some terminally ill patients admitted to Alexandra Hospital are identified as having outlived their spouses, having no kin, estranged from their families or whose families are overseas.
So together with fellow nurses and other volunteers, Ms Sim acts as a surrogate loved one, spending time with dying patients.
They are part of the hospital's No One Dies Alone (Noda) programme.
Launched here in 2004, Noda was inspired by an Oregon programme started by an American nurse three years before. (See other story.)
Ms Sim herself was spurred to volunteer after taking care of her dying mother, she said.
'The emotional care of patients was lacking,' she recalled. 'They needed to air their grievances, their fears and pain. We are there to lend an ear and a shoulder.'
Now she changes out of her nurse uniform before she goes to sit with a patient, sometimes just holding a hand, and speaking in soft voice to the patient.
Noda can now call on palliative care doctors, a social worker, dietitian, music therapist, telephone operator and two non-hospital volunteers to care for patients. They are paired with terminally ill patients, and they do this on their own time.
Ms Sim said Noda sees about 20 terminally ill patients each year. Volunteers are given a kit containing a CD player, religious texts and inspirational poems.
They may choose to read to patients, play music or even help them fulfil their last wishes. But they do not touch on religion or pray unless the patient asks them to.
Music therapy has been added in a big way as it speaks in a way that little else can.
Armed with a guitar and melodies ranging from gospel to folk songs, music therapist Melanie Kwan brings precious comfort to patients.
'The music often takes them away from their pain. Sometimes it helps them remember happier times. Some patients hum along,' she said.
Volunteers are trained through courses and workshops, said Dr James Low, head of the Geriatric Medicine department at Alexandra. Held once every three months, workshops can also be attended by members of the public. They are also given skills to cope with the emotional exhaustion of caring for the dying.
Volunteers also meet weekly to share their experiences because being an angel of mercy is not easy, they say.
Ms Sim said: 'The hardest is when you come back the next day to find that a patient you were with had died during the night - alone.'
This is the hardest blow for a volunteer, she said.
'Volunteers also need time to grieve. Some of us may attend the funeral to say goodbye, and give ourselves closure.'
Helping the dying patient fulfil his or her last wishes can also give closure, said Dr Low.
'One patient wanted to write a poem to her husband to thank him for the years they had spent together,' he recounted. 'Melanie put music to it and taped volunteers singing her words. The video was shown to her husband after she died. It not only gave him comfort, it gave comfort to the volunteers as well.'
Ms Sim said that being a volunteer with Noda had changed her. 'Holding the hand of someone who is making the last journey on his own makes a difference for him. But it also changes you. It has made a big difference for me too,' she said.
The Singapore Hospice Council is organising the inaugural Singapore Palliative Care Conference on end-of-life care here. The biennial scientific meeting, which is organised for all health-care workers who are involved or interested in end-of-life care, will be held next Friday and Saturday. Themed 'Respecting Choices', the conference will address the different issues and challenges facing health-care workers, patients and their families in dying with dignity.
The speakers include Professor Harvey Max Chochinov from Canada and Professor Cecilia Chan from Hong Kong. The conference, to be held at RELC International Hotel, will be opened by the Minister of State (Prime Minister's Office) Heng Chee How.
This article was first published in The Straits Times on August 23, 2008.
