Loh May Shan
Nurse Clinician
Khoo Teck Puat Hospital

I have been a Case Manager for the past five years. Recently, my patient Mr K, who had been suffering from chronic obstructive pulmonary diseases (COPD) passed on.

Mr K was a long-standing patient whom I had known since taking on the role as a COPD Case Manager. We had several sessions studying and chronicling how he coped with COPD as an independent individual living alone in a rental flat. He informed us that he was managing well alone at home and had a friend stay over with him whenever he felt unwell. Most of the time, he adhered to his daily medication routine. However, there were occasions where he skipped doses and had to be admitted to hospital.

At other times, he went back to smoking as a form of stress management to the detriment of his health. Mr K felt stressed by his reduced capabilities in performing everyday tasks. More crucially,he was traumatised by a thieving housemate who had robbed him of his savings and jewellery. He suffered sleepless nights and lived in fear of his housemate returning to the flat and afflicting further harm upon him. His stress was greatly alleviated when his former housemate was convicted and put behind bars.

To help Mr K cope with the stressors of life, he was provided with counseling and education sessions. I provided Mr K with a listening ear and dispensed advice within the scope of my capabilities. He would update me whenever he was in hospital for follow-up appointments or re-admitted for treatment.

With the passing of time, Mr K’s continued to regress and the option of inpatient hospice service was explored. Before he could make a decision, Mr K passed on at KTPH.

I felt bereft at his passing. Recognising that I was grieving the demise of a close patient and the importance of a de-brief, I requested to have a session with my senior who has vast experience working and caring for patients with chronic medical conditions. With the meaningful advice she gave, I was better able to move on from the episode and continue caring for my group of patients. I too, was comforted by having had the chance to speak with Mr K two days before his last relapse, and having journeyed with him till his last moments. It was also heartening to know that he was accompanied by his family at the end whom he had not mentioned previously.

Key Learning Points:

The crux of Case Management is:

  1. Case Managers support patients through different phases of their lives. In addition to educating them on coping with their dominant diagnosis, we have to listen and attend to their everyday needs and concerns too.
  2. Being aware and honouring our own feelings is important. If need be, request to speak with someone to work through feelings of grief.
  3. Carving out the space to de-brief and to have some time for self-care helps us move on and continue our work with other patients.