Rajagopalan, a 76-years old Bangalore resident, was a patient of ischemic heart disease. His carcinoma right buccal mucosa (oral cancer) was diagnosed when in highly advanced stage. Since, cheeks and jaws are highly mobile parts of the body, he was operated for tumor removal to make him a little comfortable and was given chemoradiation therapy. Since his cancer had already progressed to the final stage and spread to other parts of the body, there was nothing that the hospital could do to cure him, he was shifted home to spend his final days with his family.
 
In absence of his daughter who was held in the US due to COVID restrictions, his wife found it difficult to care for him all by herself. Rajagopalan often needed clinical support for wound dressing, infection management, and pain for which they had to get an ambulance and visit the hospital.
 
These frequent visits and travel exhaustion were further taking a toll on his health and were stressing out his wife. What they needed was a medical support that was available 24×7 and offered assured access to a doctor.
 
They reached out to Ubiqare Health to see if we could help them.
 

Ubiqare Delivers Palliative Care

Given Rajagopalan’s condition, it was clear that he was suffering a great deal during his final days. So,we delivered palliative care service to reduce his suffering and make him as comfortable as possible.
 
Our Care Doctor visited Rajagopalan physically at home to check his condition and noticed that the thigh skin flap that was put over the face during the surgery had caught infection. The family informed that they tried dressing the wound but Rajagopalan would complain about itching due to the adhesive and pull the dressing off.
 
He also had MRSA infection of the lungs which was causing breathlessness and discomfort. This bacterial infection is highly resistant to several antibiotics and is usually acquired in hospitals where cancer patients are immune compromised. If not taken care, this infection can spread to the family members who spend time in close proximity with the patient.
 
Rajagopalan already had a PEG tube inserted in him for feeding. However, the family did not know how to clean the tube and dress the open wound at the point of insertion.
 
Our Care Doctor first trained Rajagopalan’s family and caretaker on how to position him so that he could breathe a little better. She then showed how to clean the surgical wound and dressing it so that Rajagopalan wouldn’t feel the discomfort. She also guided them on how to feed him through the PEG tube and maintain the hygiene of the tube to avoid further infections.
 
For his breathlessness episodes, she trained the family and caretaker on how to use suction equipment for sputum and do nebulization.
 
For the infected areas of the body, our Care Doctor prescribed medications keeping in mind his heart disease. His pain medication was also adjusted on a daily basis to offer maximum possible relief.
 
As his illness progressed, Rajagopalan had acute bleeding episodes. Our Care Doctor provided clinical interventions at home (physically and over a video call) and helped manage the bleeding. She also offered clinical intervention when Rajagopalan experienced restlessness and extreme agitation.
 
Our Care Doctor made herself available on-call basis and visited Rajagopalan every 15 days.
 

Outcomes

Rajagopalan was under Ubiqare’s palliative care program for approximately 45 days during which we reduced his overall distress and made his comfortable. The clinical interventions provided at home ensured that they did not have to rush to the hospital for medical support.
 
The bleeding episodes that were managed at home ensured that his condition did not deteriorate rapidly.
 
The reduction in breathlessness, pain, and overall distress helped him sleep better.
 
The availability of a doctor ensured that Rajagopalan’s family had the right guidance and medical support to manage the situations on hand. Our Care Doctor’s guidance minimized further complications that could have set in due to infections.
 
The Care Doctor also continued to engage with the US based daughter and kept her posted about the situation.
 
Our palliative care support reduced Rajagopalan’s pain and suffering during his last days.