Authors:
Dr. Arindam Chaudhury, Assistant Professor, Department of Radiation Oncology
Dr. Abhijit Kumar, Assistant Professor, Department of Anasthesiology
Ms Joyeeta Giri, SNO, Oncology IPD
Ms Lhingngaineng Khongsai, NO, Nuclear Medicine & Radiotherapy
Team All India Institute of Medical Sciences (AIIMS) Kalyani, West Bengal
“In the end, it’s only you who stays by the side,” the lady sobbed, trying to hide her face.
We were struck by the simplicity of our trainer’s approach—no medicines were prescribed, only advice to keep the patient propped up with a table fan running. The patient, a known case of metastatic rectal cancer, was taking his final laboured breaths after two years of suffering. His family—his wife and teenage son—had endured this prolonged journey alongside him. As she shared, relatives had been present during the initial months, but their support gradually faded with time. In the end, it was only the palliative care team who remained, standing by them and addressing not just medical needs, but also offering emotional support in their most vulnerable moments.
CTC 7 proved to be a transformative experience for Team AIIMS Kalyani. As clinicians, we are often conditioned to relentlessly pursue a “cure” through medications and interventions. Our instinct is to act—to escalate treatment in the hope of altering outcomes. However, this experience taught us that sometimes, the most meaningful care lies not in doing more, but in being present—listening to patients and families, understanding their concerns, and responding with empathy. In many situations, this approach can be more therapeutic than complex medical measures.
Palliative care is frequently misunderstood as synonymous with end-of-life care. In routine practice, referrals are often made only when no further disease-directed treatment options remain. At the same time, we tend to overlook the profound psychological, social, and spiritual impact of life-threatening illnesses on patients and their families. CTC 7 helped us recognise that palliative care is far more expansive. It is a holistic approach that should be integrated early in the course of illness, alongside active treatment, ensuring that suffering in all its dimensions is addressed while supporting caregivers throughout the journey.
As physicians, we are also inherently uncomfortable with “letting go.” The tendency to fight till the very end—even when the outcome is unlikely to change—is deeply ingrained in our training. Yet, despite advances in modern medicine, not all battles are meant to be won. We often view outcomes through a binary lens of victory and defeat, leading either to aggressive, burdensome interventions or to therapeutic withdrawal. What we fail to embrace is the middle path—a space defined by acceptance, dignity, and thoughtful care. CTC 7 encouraged us to reflect on and adopt this more balanced and humane perspective.
Another important learning was addressing the long-standing fear surrounding the use of narcotics for pain relief. Concerns about addiction and side effects have contributed to their underutilization. While caution is necessary, ensuring a pain-free and comfortable life for patients with limited life expectancy must take precedence. Many adverse effects are predictable and manageable with appropriate knowledge. The training helped us understand these medications more holistically, including the causes of toxicity and their management, enabling safer and more effective use.
Implementing these principles, however, remains challenging, particularly in a government healthcare setting where constraints in infrastructure, manpower, and resources are common. Despite these limitations, one of the most valuable lessons from CTC 7 was to begin with what is available, rather than waiting for ideal conditions. With guidance from our mentors, Team AIIMS Kalyani has taken initial steps toward integrating palliative care into routine practice. While there is still much to achieve, these efforts mark a meaningful beginning.
In conclusion, CTC 7 has reshaped our understanding of care—reminding us that medicine is not always about adding more interventions, but often about choosing presence, empathy, and thoughtful restraint. It has highlighted that palliative care is not merely an end-of-life measure, but a continuum that should begin early, addressing the needs of both patients and their families. Above all, it has urged us to move beyond the binary of cure and failure, embracing a more humane path where dignity, comfort, and meaning define what it truly means to heal.
This project is a Lien Collaborative for Palliative Care initiative to build capacity in developing countries in Asia. The Lien Collaborative for Palliative Care was co-developed by the Asia Pacific Hospice Palliative Care Network (APHN) and the Lien Foundation.
