IN CASE YOU MISSED IT

The last gift you can give your family

This story was first published in Mind Your Body on April 25, 2013

The diagnosis of cancer almost always comes as a shock.

Although cancer is so common, affecting one in every three individuals in Singapore, no one really expects to get it.

Mr Leong, a shipping executive in his 60s, was no different.

He had come to see me in May 2010 with progressive weakness on the right side of his body.

He had not expected the diagnosis to be stage 4 lung cancer with metastasis (spread) to the brain.

He never smoked but there was a strong family history of cancer among his mother's siblings.

"After I found out I had an incurable cancer, I prepared myself for perhaps one more year of life," he recalled recently as we chatted.

"The chemotherapy was tough and, many a time, I thought of giving up," he said.

But he did not because he felt he owed it to himself and his family to give the treatment his best shot.

Thankfully, the cancer responded well to the chemotherapy. The tumours in both the lung and the brain regressed in size.

After completing six cycles of chemotherapy, he also underwent radio surgery to treat the solitary brain metastasis.

That was three years ago and Mr Leong has remained symptom-free.

The primary tumour in the lung has remained inactive but the brain metastasis has shown early signs of growing.

"I know that this is a temporary reprieve and it is only a matter of time before I'll succumb to the cancer," he said.

He knew that he had to prepare for the inevitable.

Mr Leong used to live in a terrace house but, in preparation for his financial commitments for treatment, he decided to sell the house and downgrade to an apartment.

He set aside a budget for his medical expenses and also money for his wife's living expenses after he dies.

He prepared his will to ensure that his intentions for the disposal of his assets would not be in contention.

"I find it sad to read in the newspapers about siblings fighting over the HDB flats of their deceased parents," he said.

And for him, the most important task was to get closer to God.

"This is important not just to me but also for the family - to find peace after I've passed on. So they need not worry over where I've gone," he explained.

IN DENIAL OR SUPERSTITIOUS

Unlike sudden death, which strikes unexpectedly, cancer patients have time to prepare for the inevitable.

Not everyone is as practical as Mr Leong.

Despite knowing that they have incurable cancer, some cancer patients remain in denial.

Others are superstitious and do not dare to make plans or do so when it is too late.

Almost everyone has assets at the time of his demise. Not leaving clear instructions on how these assets are to be shared often leads to unhappiness within the family.

As a doctor who walks with patients to the end of their lives, I am sometimes caught up in the legal tussles of disputing parties.

One patient saw me for very advanced cancer of the throat.

He had already undergone surgery, radiotherapy and chemotherapy, but the disease had recurred time and again.

By the time he saw me, he was almost skeletal and wheelchair-bound.

He eventually succumbed to a massive chest infection from aspiration (food getting into the lungs).

After he died, I started receiving letters from lawyers representing different parties who were contesting the validity of his will.

He had apparently prepared his will not long before he died.

Both sides wanted to know his mental state at the time he made the will.

As I was not there for the signing, nor did I know when this was done, I was in no position to comment on his soundness of mind.

Both parties then wanted me to infer from my clinical notes whether he was mentally competent at and around the time he made his will.

Naturally, one side wanted me to say he was and the other wanted otherwise.

As it is not routine at each clinic visit to specifically test for orientation to time, place and person - asking the patient what time roughly of the day it was, whether he knew where he was and his name which are the basic standards of assessing mental competence - I was unable to assist either party.

I do not know the outcome of the legal battle or whether it is still going on.

Making a will, sometimes, is treated as a harbinger of death.

For me, it is merely a small but crucial part of life - of ensuring that the harvest of our combined days is distributed as we wished.

It is a duty we owe not just to ourselves, but also to those we leave behind.

angpt@pcc.sg

Dr Ang Peng Tiam is the medical director of Parkway Cancer Centre. He has been in practice for 30 years. In 1996, he was awarded Singapore's National Science Award for outstanding contributions to medical research.

This story was first published in Mind Your Body on April 25, 2013

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