When a fellow patient dies

Therapy and counselling help people in support groups cope

When cancer patient Sally Quek heard last month that a fellow patient at the HCA Day Hospice Centre she had struck up a friendship with had died, she felt like "something had gone missing from her life".

"But I tried to control myself and did not cry," says the 62-year-old, who was diagnosed with lymphoma in 2009. Her condition is now under control.

Her friend, Mr Abdul Latip, who was married with two children, died in January at age 69. He had multiple myeloma, a type of blood cancer.

For the past four years, the pair met at least twice a week at the hospice. They played mahjong and ate together.

Madam Quek, a divorcee with two children, recalls: "We liked to joke with each other. We could talk about anything. He spoke Cantonese very well and we conversed in Cantonese."

She last saw him in November.

"He still looked okay then, but I didn't see him after that. He didn't reply to my phone messages or return my calls," she says.

If you don't see a patient for a few months, you know he has either gone to a home or has died. I have accepted this and adapted to the situation.

CANCER PATIENT GLORIA CHUAH, who attends HCA Day Hospice Centre

"I heard from a staff member at the hospice that he was admitted to the intensive care unit. Later, I heard he was discharged. I was expecting him to be back here, so I was shocked to learn he had died."

The hospice in Jalan Tan Tock Seng offers respite care, including light exercises and social outings, to about 30 terminally ill patients every week day.

Madam Quek says she has since come to terms with her friend's death. She has seen more than 40 fellow patients, including 10 she was close to, die of their illnesses over the years.

She says: "Every day is a bonus for me. I don't want to stress myself too much. It's bad for my immune system."

Her friend at the hospice, Madam Gloria Chuah, 65, who was diagnosed with ovarian cancer in 2008, shares her sentiments.

"If you don't see a patient for a few months, you know he has either gone to a home or has died. I have accepted this and adapted to the situation," she says.

The single mother of one was told by doctors last August she has only eight months before her body breaks down. She has made her will and told her family what to do when she gets "very sick".

Otherwise, life goes on. She has been going to the day hospice centre since 2009 and sees it as a second home.

Madam Chuah, who lives alone, says: "I am very happy here. I have friends and time passes very fast."

Day Hospice supervisor Nancy Soon says most patients cope with a peer's death stoically. Hospice staff would usually gather them to observe a minute of silence.

She says: "Some may get teary- eyed, but patients tend to look on the bright side and feel it's also good their friends are no longer suffering."

Ms Jacqueline Ang, the medical social worker at the hospice, adds: "Many patients have gone through ups and downs with their disease. So, when they are stable, they just want to maximise their time and focus on what they can do."

But not all cancer survivors have this positive attitude when they encounter a death in their midst.

Singapore Cancer Society counsellor Victoria Chan says: "Some may become fearful and anxious as they are brought into contact with their own mortality."

The society's Cancer Support Group has about 530 members, including caregivers, who meet more than once a month for educational and social activities.

For cancer survivors who have problems coping with the death of a peer, the society has a spiritual- care professional to help them come to terms with death and dying and maintain a sense of purpose in the face of loss and grief.

The society also offers art therapy to allow members who have difficulty articulating their feelings to do so through art.

Art therapy and counselling are also used at the Muscular Dystrophy Association Singapore to help those with the condition - a group of muscle diseases that causes progressive weakness and loss of muscle - cope with the loss of a peer.

The association has programmes for those aged seven to 16, as well as those aged 17 to 35. Each group meets regularly for social outings and talks by medical professionals.

Still, news of a peer's death can be hard to take, says Ms Sherena Loh, the association's executive director and counsellor.

"This is so especially if they have been close to that person, if they themselves have been getting weaker or if the person who has passed on is close to their age and they feel that their own days are numbered."

Since the association started in 2000, it has lost close to 40 members, usually from respiratory or heart failure. Most of them are in their 20s. There are now more than 130 members.

To help members cope when one of their own dies, Ms Loh says she and other staff members often introduce the topic of death in their daily conversations.

When someone in the group dies, the others are encouraged to go to the wake or funeral.

Says Ms Loh: "It provides closure for them."

Attending the wake or funeral also gives sufferers and their families a sense of togetherness, that "they are taking the journey together and do not have to face death alone", Ms Loh adds.

Counsellors at the association also hold informal group sessions to allow members to process their grief and cry over the loss.

Says Ms Loh: "We also get them to talk about what they remember of their friend, to let them keep their good memories of him."

While most have coped well, a handful have isolated themselves, says Ms Loh. "There's nothing much we can do if they refuse help, though we would still call their parents every now and then to find out how they are doing ."

A 28-year-old sufferer, who declines to be named, lost two close friends last year and was able to bounce back by sharing his reflections with others.

When one friend, aged 27, died last September, he gave a eulogy at the wake. The death prompted him to throw a big 28th birthday party for himself in November as he was afraid he may not have the chance to celebrate the next year. He rented a venue and invited more than 100 people.

A week after his birthday, another friend, aged 28, died.

While he feels life has played a cruel trick and his friends' deaths have dealt a "heavy blow", he says they have also made him cherish the people around him more.

Over at the Rare Disorders Society (Singapore), which has lost at least one child every year since it started in 2011, it is often the parents who feel the loss more acutely than their children.

The society has about 80 children with various rare disorders, most of whom are aged seven or eight. They meet at least three times a year for Christmas and other celebrations.

The society's vice-president, Mr Kenneth Mah, 46, says: "Most of our children are too young to understand death. If they don't get to see their friend, they won't ask why."

His daughter, Chloe, aged seven, has Pompe disease, a rare genetic disorder which causes progressive muscle weakness.

But no matter how many times he experiences other children's deaths, he says he would never be ready for that of his own child.

He says: "I doubt any parent would be."

A version of this article appeared in the print edition of The Sunday Times on March 20, 2016, with the headline 'When a fellow patient dies'. Print Edition | Subscribe