Wong Lee Fung
Care Co-ordinator
Khoo Teck Puat Hospital

Mr Lean*, a retired taxi driver was referred to the department by a palliative doctor for suspected non-compliance with his medication regime. The married 81-yearold lived in a 4-room HDB flat with his estranged spouse and one of his daughters. Despite his age and medical history, Mr Lean was cognitively robust and fiercely independent in his daily activities. He ambulated on his own with the support of a sturdy umbrella on a day-to-day basis. Positive and confident, the sprightly senior remained stoic, strong-willed and cheerful in his twilight years.

The patient suffered from chronic ailments such as chronic obstructive pulmonary disease, ischaemic heart disease and hypertension. In 2011, he underwent a major operation to treat his caecal cancer. Two years later in 2013, he was found to have developed a mass in his left lung. Mr Lean firmly declined further investigation or any invasive intervention despite the possible cancerous nature of the mass. Thereafter, he came under the watch of Hospice Home Care but was subsequently discharged due to his stable condition in December 2014.

During a recent home visit, I found his master bedroom to be neat and orderly. Due to the estrangement between him and his spouse, he had a makeshift kitchen in his bedroom which he used to cook his own simple meals. Most of the time, Mr Lean settled his meals outside before returning home. On occasions when he felt unwell, his wife would cook for him and have their daughter bring his meals to him, such was the gulf between the elderly couple who did not interact with each other. The decades-long estrangement arose due to Mr Lean’s gambling habit which was evidenced by slips of 4-D numbers hanging above his chest of drawers.

To establish rapport with Mr Lean, I commended him for being a “role model patient” based on the photograph he had taken with a team of KTPH’s medical and allied health staff which was proudly on display. The said photograph adorned the hoarding around the site where Yishun Community Hospital was being built. The elderly poster boy beamed in response to my comment.

When I asked to see his medicine supply, he proudly brandished a bottle of Theophylline tablets. I was concerned that the white oval shaped tablets had yellowish spots on them and thought that the medicine had expired. A pharmacist who had accompanied me on the joint home visit, found that the curiously spotted tablets were actually lemon flavoured Fisherman Friend’s lozenges. Mr Lean was suitably sheepish about his mistake. We also found that the senior had decanted his Mist Morphine supply into a calibrated plastic bottle for easy measurement of dosages required, not knowing that it needed to be stored in its original tinted bottle.

These home visits helped us identify the errors in his medication regime and reinforce the importance of compliance and adherence.

Mr Lean remained stoic about his occasional bouts of insomnia and pain management. He preferred to manage his symptoms with morphine and simple breathing exercises. He also declined having a wheelchair on standby.

With this, we concluded our visits with Mr Lean. His optimism left an indelible impression on me and reminded me of this quote by Martin Seligman: “Positive thinking is the notion that if you think good thoughts, things will work out well. Optimism is the feeling of thinking that things will be well and be hopeful.”

Key Learning Points:

  1. As Care Co-ordinators, we can suggest and recommend certain courses of action. It is up to the patient to decide if he or she wants to act on it.
  2. We should come up with solutions that are in line with the patient’s lifestyle and preference.
  3. When in doubt, ask more questions and obtain a colleague’s expert opinion.