“Working in a hospice is not all doom and gloom. It is a place that is buzzing with life, a place where we make things happen,” begins Nathania Oi. A senior staff nurse at Assisi Hospice’s inpatient ward, her job involves caring for patients at the end of life, managing their symptoms to keep them as comfortable as possible. But palliative care, she says, goes far beyond that.
If a patient’s last wish is to celebrate Christmas, the hospice team will make it happen even if it is early in the year, decking the room out in holiday decorations. In one instance, Oi recalls, they helped to make a hand cast for a man whose wife was seven months pregnant, so his child could hold it after he was born. She explains: “It’s about shifting the focus from quantity to quality and making the remaining days count.”
Khairunisa Binte Selamat, a senior palliative care nurse with HCA Hospice’s Star PALS (Paediatric Advanced Life Support) programme, echoes this sentiment. “Over time, I’ve come to see hospice care as an opportunity to create moments of peace and connection for patients and their families. I have learnt to appreciate the small gestures that bring comfort and dignity to those in my care,” she explains.
“It’s a privilege to be part of such an intimate, significant time in their lives.”
There are some paths in life that are a calling and palliative care feels like one of them. Long, irregular hours and a heavy emotional weight are part and parcel of the job, but the easy acceptance with which the nurses make their sacrifices speaks volumes of their selflessness.
“I experienced a few losses in my family when I was very young,” shares Lee Jing Ru, an advanced practice nurse at Dover Park Hospice. “When my loved ones passed away at that point in time, I felt that some of them might not have been the most comfortable. I chose to go into palliative care because I would like to provide comfort and relief to other patients.”
“I want to do this job for as long as possible. But when I can’t, I hope somebody else can continue to do this meaningful work”
For Lee, the most challenging part of the job is seeing patients reject the nurses’ care even when they are suffering. She recounts an example of a patient who left a lasting impact on her—a woman with advanced stage pancreatic cancer who did not believe in western medicine. “She would refuse medications even though she was in pain. That was heartbreaking to watch because we did have the means to help her. But at the same time, we also wanted to maintain her personhood. Eventually, she agreed to let us manage her pain after some time.”
It is situations like these which make it evident that caring for a patient goes beyond the physical. It is a thing of great nuance, requiring nurses to get to know every patient as individuals—each with their own beliefs, preferences and decisions—and not just by their diagnosis. “It means being there emotionally and spiritually, providing reassurance, compassion and presence,” Khairunisa explains. “It’s about creating an environment where patients feel safe, loved and respected in their final days.”
The deep emotional ties the nurses have with their patients are only natural. “We tend to be quite close to our patients, so when they deteriorate and pass on, it’s also difficult for us to cope emotionally. I do cry and sometimes together with the family members. One of my seniors once told me, ‘just don’t cry louder than their loved ones’,” Lee laughs. “But we cry because we feel for them.”
It’s one of the hardest parts of palliative care, Khairunisa muses, seeing the emotional pain that families go through as they prepare for and deal with loss. Being confronted with death on a daily basis inevitably takes an emotional toll and this is something all hospice nurses have to learn to handle. “I focus on the value I bring to my patients’ final days. I remind myself that I’m there to help them transition with dignity and as little pain as possible,” Khairunisa shares. Having healthy outlets like having a hobby or practising mindfulness is also crucial.
At Dover Park Hospice, Lee explains, the palliative care team does an honour walk every time a patient passes on, lining up in front of the ward to pay their final respects as the patient is pushed out. It’s a form of closure for the team as well, allowing them a moment to process their emotions and reflect on the journey they have taken with the patient.
One thing all three nurses agree on is the importance of a strong support system—colleagues, family and friends that they can lean on to lighten the load. Within the hospice nurse community, especially, is a strong sense of camaraderie brought about by a common purpose and a shared understanding of the job’s tough demands and immeasurable rewards. “It is a small, close-knit community,” Oi shares. “I feel very comfortable to pick up the phone to call other hospice nurses when I need something.”
To Lee, guiding her fellow colleagues and junior nurses is also a vital part of the job. To share her knowledge and experiences and to offer a listening ear are ways to ensure the longevity and the strength of the community. She explains: “I want to do this job for as long as possible. But when I can’t, I hope somebody else can continue to do this meaningful work.”
As for how palliative care as a whole can grow in Singapore, Oi notes: “I hope conversations about death and dying can be normalised within our homes and communities through greater public awareness.” With this, she explains, patients may be more open to receiving palliative care earlier when they are diagnosed with life-limiting illnesses.
It is an aim that organisations such as the Singapore Hospice Council have already been working towards, engaging the public for better death literacy and awareness of palliative care through workshops, community events and resources. It might seem like a tall order in a society where death is sometimes still seen as a taboo and an uncomfortable topic of conversation, but the steps to change don’t have to be big.
“We can start by being open and talking about palliative care and advanced care planning with friends and family,” Lee explains. “Consider your preferences. What sort of care would you like to receive and where would your preferred place of care be?”
“There is a misconception that hospice care is giving up, but in reality, it is about enhancing the quality of life for patients and ensuring their final days are filled with dignity, peace and comfort”
At the end of the day, the goal is to nurture compassion in our communities—not just for those facing life-limiting illnesses, but also for their caregivers and their loved ones. Khairunisa adds: “I hope that there will be more training for healthcare professionals to provide compassionate care, and that patients and families have easier access to resources, emotional support and counselling throughout the process.”
Eventually, her hope is for palliative care to become more integrated into everyday healthcare, with greater awareness among the general public about the benefits of early palliative care intervention. She shares: “There is a misconception that hospice care is giving up, but in reality, it is about enhancing the quality of life for patients and ensuring their final days are filled with dignity, peace and comfort.”
Above all, when the three nurses speak of their jobs, amid talk of hardships and sacrifices, it is their genuine care and love for their patients that shine through. They speak of meaningful moments spent together and the impact that their patients have left on their lives.
“Palliative care is about going back to the basics of humanity,” Oi concludes. “My work has challenged me to step out of my comfort zone and be intentional in finding out more about the people I am caring for, both my patients and their families. All of them have a story to tell and I am humbled by what I learn from each of them.”
Vogue Singapore’s November ‘Nurture’ issue is now out on newsstands and available online.
