This interview is the second of the mini-interview series featuring members of the 17th Council of the Asia Pacific Hospice Palliative Care Network (APHN).
This month, we interviewed Dr Masanori Mori, one of the Co-opted members[i] of the Council. Dr Mori is a palliative care physician at Seirei Mikatahara General Hospital, located in Hamamatsu city, Shizuoka Prefecture, Japan.
Challenges in clinical practice and unique approaches
I was trained and practice palliative care in oncology for 10 years, during which, I had faced many challenging problems, but there are two distinct situations I encountered which I will like to share.
The first was providing palliative care for adolescent and young adult patients (aged 18 – 39) when I was a fellow, partly because we were in the same generation. We could provide symptom management, but many of them had severe psychosocial & spiritual pain, especially regarding them having to face early, premature death. I remember clearly a patient asking me in front of his family, “What would you do in my shoes?” It got me thinking. What would I do being in my 30s and facing death? I thought there was no right answer to that, so I had some difficulty when faced with such questions. We had a good patient-physician relationship. I felt like I was asked the question not only as a physician, but as a person. So I shared a part of my life with the patient, and we had some good conversations. I was sharing what my hobby was, which was “Haiku”, a very short form of Japanese poetry. After he passed away, the patient’s family engraved the haiku poetry I wrote for him on his tomb.
I feel that when we are facing such situations where a patient has significant psychosocial distress, what we could do is to sit down near the patient, try to understand where his or her suffering comes from, and adopt a multidisciplinary approach to discuss how best to support the patient.
The second challenge I have faced was, no matter the improvements in palliative medicine, occasionally we still have difficulty in relieving severe symptoms at the end of life. For example, shortness of breath just before death can be quite difficult to manage even with the use of parenteral opioids. We sometimes do palliative sedation to relieve intractable symptoms like refractory shortness of breath. But before its initiation, it can be difficult to say how much palliative treatment is sufficient enough to say “this symptom is indeed refractory”, even with the best evidence and discussions among palliative care experts. Going forward, we need to improve strategies of symptom management at end of life
One unique approach I can share is that recently, there have been some trends to the early integration of oncology and palliative care in Japan. One of such activities is a “two-physician system” for advanced cancer patients; while a patient is receiving anticancer treatment by an oncologist, a palliative care physician within or outside the institution sees the patient as the other main physician, not as a consultant, alongside the oncologist. I feel that this new, collaborative approach allows for a smooth transition to palliative care, lessening the sense of abandonment felt by patients. However, this practice is still in the pilot stage in Japan.
One thing I hope to do during my term on the APHN Council is to contribute in the area of research. For example, I am interested in cross-cultural studies in Asian and Pacific countries to understand similarities and differences in palliative care practices. Such data could help us appreciate the situations of each country, and lay the foundation for future collaboration.
Life and inspiration
My friends and colleagues are usually surprised to know that I am interested in Haiku poetry because it is not very popular among people of my age. (Haiku poetry is usually popular among older people in Japan.) I have 4 kids, so I also enjoy playing with them.
There were many people who inspired me in my life; my dad and mum, my previous and current mentors in US and Japan, and Dr Shigeaki Hinohara who was one of the founders of the APHN. Many of them share similar characteristics in terms of how to view the world, manage challenges, take collaborative actions, and enjoy life. They all have certain aspects which became my inspiration in one way or another.
For example, Dr. Hinohara’s writings and works are very inspirational. I was so inspired by his altruism, perspectives, and medical and social activities that I visited him at St. Luke’s International Hospital 10 years ago when I was a palliative care fellow in Houston. Dr. Hinohara was 95 years old then. It was about 10-15 minutes when we talked; Dr. Hinohara listened to me, and shared his vision of not only launching a graduate medical school but also ceasing wars worldwide. He left the world at the age of 105 but he pioneered in numerous fields in medicine ranging from preventive medicine to end of life care , as well as medical and nursing education. Moreover, Dr. Hinohara contributed to the entire society by publishing a number of million-seller books such as “Living long, living good”, and initiating something very new such as so-called “Smart Senior Association”.
As a new member, I very much look forward to working with you all at APHN!
By: Joyce Chee, APHN Executive
The article first appeared in the APHN newsletter Issue 34.
All information is correct at time of publishing.
[i] The APHN Council consists of 7 members to be appointed by sectors on a rotation to be determined alphabetically according to the name of the sectors (Constitution 12.2a), 7 elected members, and 6 Co-opted members.