Dr. Teo (Consultant)
Morning, team. Let's see Auntie Siew Lan first, can? She's the one with advanced breast cancer, metastatic to the spine and liver. Admitted three days ago for pain crisis.
Dr. Priya (Registrar)
Good morning, Dr. Teo. Auntie Siew Lan's pain is much better already lah. We converted her to fentanyl patch 50 micrograms per hour and her pain score came down from 8 to 3. She managed to sleep through the night for the first time in two weeks.
Dr. Teo (Consultant)
Very good. That's encouraging. How about her mood? Last round she was quite down, saying she don't want to mafan the family anymore.
Nurse Specialist Amy
I chatted with her yesterday. She's still quite sian about the whole situation, but she opened up a bit more. Her daughter has been very filial — comes every evening after work, brings her favorite porridge from the hawker centre. That seems to help her spirits.
Dr. Teo (Consultant)
Good, family support is so important. Have we started the ACP discussion yet? Her prognosis is quite limited — I think weeks to a few months at most. Better to talk about it now while she's still alert and comfortable, right?
Dr. Priya (Registrar)
We tried to bring it up, but her son wasn't comfortable. He said, 'Don't tell my mother she's dying lah, later she give up hope.' The daughter is more receptive though. Quite common this kind of situation hor — the family members have different views.
Dr. Teo (Consultant)
Yes, very typical. This is the collusion of silence we see a lot in Asian families. We need to respect their concerns but also advocate for Auntie Siew Lan's autonomy. Let's arrange a family meeting — include the son, the daughter, and maybe the MSW can help facilitate.
MSW Rachel
I can arrange that for tomorrow afternoon. I've already met the son once — he's actually very caring, just scared lah. He mentioned financial worries too. I'll check if they're eligible for Medifund assistance.
Dr. Teo (Consultant)
Thank you, Rachel. Also, I want to check — has anyone discussed her spiritual needs? I know she's Buddhist. Some patients at this stage find comfort in having a temple volunteer visit. We should offer that option.
Nurse Specialist Amy
She actually asked about that herself. She wants to listen to Buddhist chanting — I showed her how to use the ward iPad for that. She said it makes her feel very peaceful. She also requested vegetarian meals for the rest of her stay.
Dr. Teo (Consultant)
That's wonderful that she can express her wishes. OK, so the plan is: continue current pain regimen, family meeting tomorrow with MSW support, explore ACP gently, and look into Medifund. Anything else?
Dr. Priya (Registrar)
One more thing — her liver function is trending up. Bilirubin was 45 yesterday, up from 30 last week. If it keeps rising, we may need to discuss with the family about what it means for her trajectory. I'll monitor closely.