Nursing without borders – a story from Thailand

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In another story in celebration of International Nurses Day, Dr Issarang Nuchprayoon from Bangkok, tells the inspiring story of a nurse, Khun Meow, who went way above and beyond her professional responsibilities to bring comfort and relief to a young adolescent boy and his family.

The story begins
The story begins in 2010 when I was consulted about a 14-year old adolescent boy named Tone who had survived surgery for medulloblastoma, a malignant brain tumor. He had an unusually slow recovery and was in the hospital for several month for radiation after surgery. I was there to advise on chemotherapy. It was the most unusual timing that our hospital was to close for political reason as there were political demonstrator invasion into our hospital at that time. The hospital had to be evacuated and every patient had to be transferred out to other hospitals. Tone therefore could not receive chemotherapy at our hospital, and I had to arrange to send him back to his hometown cancer centre in Chiangrai province, 900 km north of Bangkok.

Nurse Khun Meow
Tone and his family, brother Game and his mother, got to know Khun Meow very well. I knew Khun Meow only as a nurse in the paediatric surgery unit, which I rarely had contact with. Tone had not recovered well at that time of transfer but with the unexpected urgent plan of moving back home, Khun Meow provided accommodation for the family at her home for a few days during transit. Tone went to Mae Sai, 100 km further north, to the Chiangrai hospital.

The next three years
Having been through tough times and a long stay during surgery and radiation at our hospital, Tone refused to get further chemotherapy. He refused to spend any more time in hospital. He is a big adolescent for his age and was determined to rehabilitate himself to the point that he could go back to his school. He was a clown in that school due to his disability. Over a course of 3 years, life changed. He changed school. He got a close friend. His mom made a living selling goods at the Thai-Burmese border. His brother got accepted to study in Bangkok. And finally, cancer recurred.

A crash course on paediatric palliative care
Tone called Khun Meow every month to let her know that he was better and was going to school. But in the third year at home, Khun Meow began to hear of Tone’s new symptoms, suggesting recurrence. He refused to go to any hospital. When the news arrived that Tone was in pain, Khun Meow called me up. I did not recall having met Tone or his family at that time as I had met them only once 3 years before. Khun asked me about palliative care, how to provide it and what she could do for the family. I gave her a crash course on paediatric palliative care.

Khun Meow visits the home
Tone suddenly got a high fever and was probably in shock so his family took him to a local hospital. He had urosepsis and after being administered antibiotics he woke up and was furious that he was in the hospital. It was difficult to evaluate what was going on with Tone as he, now 17, only wanted to be at home. We only know that he was paralyzed from the neck down. Khun Meow did an extraordinary thing. She took a vacation, travelled to Tone’s home, at her own expense, and assessed the situation. She reported back to me on Tone’s quadriplegia, clinically a sign of new metastasis of his brain tumour, and urinary retention. She went there again two weeks later to teach his mom and close friend the appropriate nursing care for people with paralysis. She confirmed that Tone indeed refused hospitalised care even though it meant death. His mom reported that Khun Meow could communicate well with Tone, which was very helpful.

Advance Care Plan
Khun Meow returned with a much clearer picture of Tone’s clinical condition. We could make a plan and then she went to visit Tone for the third time, a month later. This time I went to counsel Tone and his family on making an advance care plan. Tone was well taken care of by his mother and close friend and was without bedsores. I could see how much Tone and his family members appreciated Khun Meow’s help and kindness to them.

Khun Meow continued to make contact with Tone’s family until his peaceful death two weeks later.

The relationship continues 
Tone’s brother volunteers with us, sharing Tone’s story at public events. From that time on, Khun Meow volunteered to help me in palliative home care for several patients, mostly elderly patients. For home palliative care, a doctor like myself may bring peace of mind to the family but it is the nursing skills that help bring physical comfort to patients through their carers. Khun Meow had made it possible for lay people to take care of their loved one efficiently.

About the author
Dr Issarang Nuchprayoon MD PhD works at the paediatric palliative care service, Faculty of Medicine, Chulalongkorn University and is also the Secretary General of the Wishing Well Foundation in Thailand.

From ehospice