This is a story about a man I met during my stay in Palliative Medicine.

Well, not exactly his story, but more of what I learnt from him during the last few months of his life.

Mr Khairi (not his actual name), he was 38 years old at that time, was referred to us from Urology department for pain control, having referred to them from Hospital Kuala Lumpur for further investigation of a kidney tumour. The way he presented was unusual – he had a lump over the jaw, which was quite painful and would not stop growing. Biopsies and scans showed that he had a type of cancer that came from one of his kidneys.

As with so many other patients, it took us a bit of time to introduce him to morphine and how to best use it so that his pain can be controlled and side effects will be minimal. No, it does not cause addiction if used in a person who has real pain, and it does not make someone drowsy for the whole day that they end up only sleeping and do nothing else.

By the time he was discharged, his pain was fairly well controlled, not totally reduced though. Like I said, as with other Malaysians, he’s afraid that he’d “depend too much on the medications” so he would want to keep the dose to its bare minimum. Well, quality of life is what the patient says it is.

He came in and out of our ward mainly for symptom relief. At the same time, he was also seeing oncologists in HKL for treatment of his cancer.

What strikes me the most about this man is the way he always smiled.

He would smile at us even when he comes in with pain or vomiting.

His smile would even become bigger when his pain is reduced, and vomiting has stopped.

Obviously he would smile at us all when he said goodbye everytime he’s discharged from the ward.

His wife was as friendly, but obviously constantly worried about him.

At one point he did another CT scan after completion of some radiotherapy to see whether his cancer has reduced in size, or spread further.

During one clinic review, I had the unfortunate (or honoured?) task of telling him the findings of his CT scan, which showed that the cancer has spread to more organs.

As always, he came in smiling, walking with his walking stick. His wife, with a worried face but smiling nontheless, followed in. He was a lot thinner than the first time I saw him. It looked like if the wind blows, he’d just fall off without the walking stick.

We started with the usual chit chat. About how his pain has been. How his life has been so far, what does he do at home with all the time in his hands. How many children he has and how were they coping.

In the end the dreaded question surfaced, “Doctor, how was my scan?”

I explained it to him, in an honest but tactful manner as taught and practiced. The fact that despite treatment, the disease has spread. Probably the oncology side may have something else that they could offer. Since he’s young, they might just go all out to try and stop the spread.

“Actually doctor, the oncologist has already told me even before the first round of treatment. She said this tumour might not respond very well. If the first round was not effective, then nothing probably would…” he said with a quiet voice.

“So now we’ll just wait and see…” said the wife.

She started crying. He stayed in silence.

It was all I could do to prevent myself from starting to cry.

“It’s ok, doctor,” he said. “I understand. They have told me about this earlier.”

He looked at his crying wife. His smile, sincere as always, although smaller than what he came in with, is still there. “It’s ok. We’ll be fine. We’ll be fine.”

* * *

They left the room after his wife has stopped crying, a few more quiet words, and promise to come back if he has any problems.

I closed the door to the clinic, sat on the examination couch, and started crying myself.

What a loss for this world, a fine, polite young man, leaving so early in this life.

* * *

A few weeks later, he came back to our ward. Extremely thin this time, his eyes almost protruding because of the loss of surrounding fat. He smiled, as always, but it looked a little sad and tired.

This time he had low blood sugar. No matter what we did, it stayed low. It was difficult to put in IV lines for him this time around, as he was dehydrated. He did not even complain when we had to prick him a few times.

There’s a period of time before a person’s death that they appear to not be in this world anymore. The way they look at you, the way they smile, the way they stare into space, the way they half-listen to anything anyone says…those signs make them seem like their bodies are still alive, hearts still beating, but their souls are trying to leave their bodies. You could feel that the end is near.

That admission was his time.

It was a Sunday. I was not ready to discharge him yet, but he kept on asking his wife to bring him home. I was worried that she would not be able to cope, and she was as worried too. However, since it was his request, both of us agreed that perhaps it would be best for him to stay at home.

“May I, go home, doctor?” he asked, with a smile, but his eyes staring into space beyond me.

“Of course, of course,” I said.

As his wife pushed him out of the ward, he gave a wave goodbye to me, of course, smiling.

* * *

It was the last time I ever saw him.

His cousin was actually one of our mortuary staff. He brought the news to me one night when I was on call, a few days late.

All I could remember was his smile.

* * *

This song always reminds me of him, everytime it’s aired on radio. The last few verses are so real, it cuts really deep inside.

“Teman Pengganti” by Black and Malique.

Ketawa bersama, menangis bersama

Ku bersumpah harap kita mati pun bersama

Sejak dua menjak ini, makin kerap ku diganggu visi

Bila celik, juga bila mimpi, aku nampak kau, tapi bukan aku yang di sisi

Dia membelaimu dengan izin dan permisi, sentuhan katanya semuanya kau iakan

Sentuhan jari kau diamkan dan biarkan

Aku redha walau tidak ku damba

Walau hampa semuanya dah dijangka

Beberapa purnama dulu cinta bertahta

Kenangan dibina kita indah belaka

Ketawa bersama, menangis bersama

Ku bersumpah harap kita mati pun bersama

Namun hakikatnya, bukan mudah aku sembunyikan gulana-gundah

Segalanya kan berubah

Dengarkan apa yang ku mahu luah

Rahsia ini telah lama ku pendamkan

Tiba masanya segala-galanya ku ceritakan

Aku kan pergi, pergi ku tak akan kembali

Tiba masanya kau cari teman pengganti

Dalam dunia yang maya, prejudis dan bias

Kita tak terlepas dari terkena tempias

Rimas, ditindas, sembunyi dalam puisi dan kias

Tidak kau bidas, tak berpaling walau sekilas

Hanya kau yang tahu kodeksku yang kompleks

Dalam disleksia cuba kekal dalam konteks

Bila dunia seolah tak memahami, kau sudi selami, dalami dan mengalami

Setia mendengar, sentiasa hadir

Ingat setiap ulangtahun, setiap hari lahir

Tiba pagi Syawal, kaulah yang terawal

Syawal yang terakhir ini pasti rasa janggal

70 000 hijab harus ku singkap

Ku sorok kitab balik tingkap penjara hinggap

Dalam diam ada seorang yang ku puja

Kau teristimewa tapi Dia yang sempurna

Sejak dua menjak ini, ku mencari fungsi kewujudan

Dalam persekitaran yang penuh kejumudan

Terperangkap dalam jasad, ku keliru

Mujur ada kau si peneutralisasi pilu

Namun aku tetap murung, berkurung

Tubuh makin susut, menunggu tarikh luput

Komplikasi di halaman rusuk kiri

Makin sukar nak bernafas, nak bergerak, nak berdiri

Lagu ini yang terakhir aku sajikan

Kalau rindu nanti bolehlah kau nyanyikan

Jaga diri, jangan makan hati

Yang patah kan tumbuh, yang hilang kan berganti

Bilik dah ku kemas, katil dah ku rapi

Cincin, kunci, dompet dalam laci

Ada sikit wang, itu saja baki

Moga-moga cukup untuk majlis itu nanti

Aku kan pergi bertemu kekasih abadi

Tiba masanyaKau cari teman pengganti

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