DEATH. It’s that five-letter word no one wants to talk about. Yet the global health crisis underscores the fragility of life and requires that each of us plan ahead in the event of our untimely passing, says palliative care physician Dr Nadya Watson.
Watson has been called ‘Dr Death’ and the ‘grim reaper’, but despite the misconceptions surrounding her job, she provides an essential service for her patients and their families.
As a palliative care physician, it is her job to improve the quality of life of her patients, particularly those who are suffering with a terminal illness, and to ensure that their transition from life to death is as seamless and painless as possible. In most cases, Watson attends to persons who have been told they have months or mere weeks to live.
“I don’t treat the illness, rather I treat the person as a whole. A person is more than an illness, for example a young person who has cancer or renal failure may be the sole breadwinner in their family and may worry about what could happen once they die. Many of my patients have children, a home and a mortgage. We prepare them for what is to come and we make sure that all those aspects are taken care of. That may mean calling in social workers or financial advisers to help patients put things in place,” explains Watson.
A major part of the physician’s job is symptom management which includes treating pain, nausea, constipation and insomnia. Her goal is to decrease discomfort and provide patients with continuous support to improve their quality of life - however long or short it may be. Some patients may need to undergo cancer treatment. In such cases it falls upon Watson to determine a special diet which would help them gain weight and muscle mass so they could withstand the rigours of intense chemotherapy. She also offers emotional support for her patients and their families.
Ensuring some measure of comfort
As morbid as it may sound, Watson wants to make her patients comfortable with the idea of death. But in a society such as ours where the subject of death is taboo, many resist the thought. However most times, the families of her patients return to thank her.
“Even though people don’t like to think about death, the reality is that we’re all going to die. My aim is to ensure that you die with dignity, on your own terms and not in a hospital next to strangers,” says Watson. “When I meet with patients I ask them what is more important to them: quantity of life or quality of life. If they choose quantity, my aim is to give them what they want and push all forms of treatment. But another person whose body is riddled with cancer may be suffering and upon weighing the pros and cons they may decide that their quality of life is more important and so I treat the symptoms and ensure that they are not uncomfortable.”
Upon meeting with patients, she sits with them to work out a personalised medical plan, known as an advanced care directive which covers everything from symptom relieving treatment, last will and testament, estate planning and funeral arrangements. Some have even written about how they wish to be remembered. The advanced care directive eliminates panic, confusion and conflict among family members. Everything is put in place so that when the time comes the family can focus solely on the grieving process, says the physician.
Watson has an advanced care directive of her own in the event of her death.
“It may sound morbid but I’m not afraid to die. Maybe that’s because I’m around death so often. My greatest fear would be not putting things in place, especially since I have two girls,” she says.
Helping in the time of need
Prior to becoming a palliative care doctor, Watson was an anaesthetist but working in operating theatres didn’t fulfil her desire to interact with patients. She was asked to attend a meeting on palliative care which she knew nothing about at the time and emerged from the conference with a yearning to switch medical fields and become a palliative care doctor. She’s been in the field for seven years and is one of the few palliative care physicians in T&T.
“Helping a person in their time of need - I think that’s exactly what we as doctors ought to be doing,” she says.
As a palliative care physician, Watson knows how to break bad news. She believes it is the patient’s right to know what is happening to them and oftentimes that means telling them that their life expectancy has been reduced to a few months. Most of her patients have had ‘“good deaths”, that is to say, they died peacefully.
Although the nature of Watson’s job puts her in constant company with death, she has not grown desensitised; rather, she is attached to her patients and wishes they could all defy the odds and continue living.
Watson says people - even those who are enjoying good health, should seriously consider putting things in place in the event of their death. Doing so is not macabre, but practical, she adds.
“Everyone should know how they want to die because it can happen at any time,” says Watson. “Life is so , especially at this time where people have lost their lives unexpectedly from coronavirus. People who have tested positive for the virus react in different ways. Some end up in high dependency and intensive care where they are intubated and unable to move and communicate. How traumatic it must be for families in those situations who don’t know what their loved ones’ final wishes are. And that is the case with most families.”
Later this year Watson will be partnering with investors to open a hospice in San Fernando, the first of its kind in South Trinidad which will seek to give patients with six to 12 weeks to live the best quality of life.
If all goes to plan, she hopes to expand the service into other parts of the country where the terminally ill will be afforded their right to die with dignity.