Where to die?

[toast1]

I have terminal cancer and the grim reaper is looking through my window.

 

I'd rather die at home, but the issue is how to manage pain, which palliative clinics are good at.

 

I have lots of morphine at home, which can control pain, but have been considering various palliative hospices and hospitals in BKK.

 

Has anyone had experience with this.

 

 

thanks

 

[VinnieK]

Can you afford an open-ended stay at a hospital? 

[toast1]

It won't be for that long, a week or two, so yes.

 

[gargamon]

Are there no hospices here?

 

I read about a place in CM that houses people with Alzheimer's, etc. that has a very good reputation worldwide. Maybe you could contact them and inquire what they do with patients nearing the end. Maybe someone else has the contact info. 

[ezzra]

Which ever you look to get a palliative care in Thailand it will be expensive best if you can go back to your country of origin if possible, i have noticed you member's name as @toast1, you have chosen this name with a  a tongue in cheek, morbid humor in minds?

[lopburi3]

Palliative clinics and hospice facilities are not much of a thing here.  If you have drugs perhaps stay at home and have someone treat you if able - or stay in hospital for last days.  Outside hospital most effective drugs are not easily available - and even in hospital expect best to make arrangements with a doctor willing to use prior to need.

[Gaccha]

This place looks promising, the Camillian Hospital.

[Sheryl]

There are no hospices here like in the west and generally speaking palliative care is a weak area in Thai medicine, but there are a handful of good, western-trained  palliative care specialists providing good care at a few hospitals. It is possible to get help from them as either and inpatient or outpatient, if admitted to hospital it is critical to be admitted under the primary care of a palliative specialist and to sign that hospital's paperwork for no "extraordinary measures" life support (i,e. to be designated Do Not Resuscitate). Even if you have an Advanced Directive signing the hospitals's own form is important.

 

Whether to stay at home or be admitted comes down to (1) whether you have reliable and capable care-givers and (2) whether your pain and other discomforts can be managed with oral medications (or, sometimes, patches). Unlike in the West there are no at-home morphine drips and the like so if it comes to the point that IV medication is required, you need to go into the hospital.  Might also need to go into hospital  if the general  at-home nursing care becomes too much for caretaker(s) to manage. If under the care of one of the Palliative specialists mentioned below, who are affiliated with very good private hospitals that have a palliative care team, and with the necessary paperwork signed as per above, your hospital stay will be comfortable.

 

Many people go back and forth between hospital and home in the final weeks and are admitted for the final days. I do know of a few (very few) cases that were able to die comfortably at home; these all had very devoted spouses providing 24/7 care, and willing and able to make fairly complex decisions about medications etc on their own - all these  spouses were Western (not saying a Thai spouse cant do this but Thais tend not to be very comfortable making independent medical decisions and to prefer to rotely follow a doctor's instructions. In terminal care that doesn't work well as needs keep changing). Another factor was the availability of fentanyl patches when the patient could no longer swallow oral medication. As of about 2 years ago fentanyl was not available for some reason, I don't know if that has changed.

 

These are Palliative specialists I recommend:

 

1. Samitivej Hospital

https://www.samitivejhospitals.com/doctor/detail/pongparadee-chaudakshetrin

Very kind and knowledgeable older woman, and the hospital has excellent nursing care.

 

2. Bangkok Wattanaosoth Hospital (the cancer hospital in the  Bangkok Hospital complex)

https://www.bangkokhospital.com/en/doctor/dr-darin-jaturapatporn

https://www.bangkokhospital.com/en/doctor/dr-laksamee-chanvej

Both Western trained in palliative care. I have visited patients admitted for palliation there and their accommodations and care seemed comfortable.

 

All of these doctors have larger teams working with them and can arrange for a range if treatments, not just medications (for example, nerve blocks or nerve ablations).

 

I suggest you have a consultation with one or more of these doctors and arrange to get under the permanent and primary care of one of them. When you meet them, discuss frankly what can be done on an outpatient basis especially if you are no longer able to swallow, and ask if the hospital has a special ward or section just for palliative care and, if possible, visit it. You might also ask about home care options and whether a morphine drip might be possible with nurses from that hospital in attendance (last time I checked it was not but this could have changed, no harm in asking).

 

Feel free to contact me by PM if needed

 

 

[TallGuyJohninBKK]

21 minutes ago, Sheryl said:

Bangkok Wattanaosoth Hospital (the cancer hospital in the  Bangkok Hospital complex)

 

Excellent info and post, Sheryl....

 

One question, re the Bangkok Hospital doctors you mention above, are they only going to be willing to provide palliative care for people with cancer, or, they'll do regardless of the underlying illness?

 

[Sheryl]

41 minutes ago, TallGuyJohninBKK said:

 

Excellent info and post, Sheryl....

 

One question, re the Bangkok Hospital doctors you mention above, are they only going to be willing to provide palliative care for people with cancer, or, they'll do regardless of the underlying illness?

 

They will provide palliative care to anyone with a terminal condition. Or even a non-terminal condition if it involves chronic pain.

[OneMoreFarang]

3 hours ago, toast1 said:

I have lots of morphine at home

Just make sure you have enough of that. I know a guy who used the rest of his supply to make the final trip as smooth as possible and at a time of his choosing. 

 

[bamboozled]

Toast1, good luck to you, brother. I can't imagine what's going through your head in these moments. I'm sure everything and perhaps nothing, at the same time. We all will tread this terminal path, come one day. Our communal, very democratic, end. That gives me some solace, to think about my own death and know that it is not just me, it is nothing personal, it is the natural cycle of being. You are not alone and we will all be there alongside you. Ah <deleted>, now I'm crying. Hugs, my fellow traveler.

[hydraides]

How old are you by the way............ and what cancer are you suffering from? 

 

I would suggest macro dosing on mushrooms or even try DMT, it might help with the fear you dying

[Freddy42OZ]

5 hours ago, toast1 said:

It won't be for that long, a week or two, so yes.

 

All I can say is I wish you a peaceful departure. 

Vale Toast1

[Sigma6]

Jeez, reality bites...

 

I wish you well on your journey Toast1.

 

Peace to you, brother

 

`

[Sheryl]

7 hours ago, gargamon said:

Are there no hospices here?

 

I read about a place in CM that houses people with Alzheimer's, etc. that has a very good reputation worldwide. Maybe you could contact them and inquire what they do with patients nearing the end. Maybe someone else has the contact info. 

No, there are not (hospices here)

 

The place in CM you are thinking of is this:  https://mckean.or.th/

And it is a good option, less costly than a hospital (if they have an available bed)

 

But OP is in Bangkok and may not be physically up to travelling to CM.

[Sheryl]

7 hours ago, toast1 said:

It won't be for that long, a week or two, so yes.

 

Make sure you have not underestimated what even that can cost. For proper palliative care you are not looking at a government hospital. Private hospital care will run to at least 10K a day once room, board, medications and doctor visits etc are factored in. .And they will require an upfront deposit before you go in.

[bignok]

What if it is 1 or 2 months? Talk to the experts. Good luck. 

[proton]

Good luck Mr toast and wishing you a passage as pain free as possible.

[toast1]

Sheryl & others

Thank you for your excellent advice.

Most useful.

 

I am in Palliative care now, its not so cheap, but I have found the doctors very helpful, with good English and an understanding of Living Wills etc.

Treatment has been efficient and reasonable.

 

There's Koon, Brumengrad, St Louis etc. in BKK, Koon being the cheapest.s

 

Though, what the add on costs will be, I don't know.

 

Cheers

 

 

 

 

 

 

 

 

 

 

[TallGuyJohninBKK]

56 minutes ago, toast1 said:

There's Koon,

 

What's "Koon"?

 

[toast1]

Palliative hospital

 

[lopburi3]

57 minutes ago, TallGuyJohninBKK said:

 

What's "Koon"?

 

https://www.koonhospital.com/?gad=1&gclid=CjwKCAjwm4ukBhAuEiwA0zQxk84qSDeYG3dZm79bsRD8-8M_kaWCjCg_xfM50-GW8xOnYGY7b9Kl3xoC3Q8QAvD_BwE

[toast1]

The problem with Koon, is they didn't have anyone I could speak to who spoke English.

Probably the doctors did, but their English was very bad, so I didn't go there.

[TallGuyJohninBKK]

55 minutes ago, lopburi3 said:

https://www.koonhospital.com/?gad=1&gclid=CjwKCAjwm4ukBhAuEiwA0zQxk84qSDeYG3dZm79bsRD8-8M_kaWCjCg_xfM50-GW8xOnYGY7b9Kl3xoC3Q8QAvD_BwE

Thanks, never heard of this place/name before... Looked at their website, via Google Translate (they also have an EN version for some pages):

 

Deluxe Balcony Room:

 

"Service rate: 5,500 baht/day

Click to inquire about the June 2023 promotion starting at 3,600 baht/day* from 1 - 30 June 2023 only."

"Doctors and nurses take care 24 hours a day.
Relatives can visit 24 hours a day."

 

[proton]

5 minutes ago, TallGuyJohninBKK said:

Thanks, never heard of this place/name before... Looked at their website, via Google Translate:

 

Deluxe Balcony Room:

 

"Service rate: 5,500 baht/day

Click to inquire about the June 2023 promotion starting at 3,600 baht/day* from 1 - 30 June 2023 only."

"Doctors and nurses take care 24 hours a day.
Relatives can visit 24 hours a day."

 

Website is in Englsih as well, actually just down the road from us but never heard of it before. One to bear in mind.

[KannikaP]

23 minutes ago, TallGuyJohninBKK said:

Click to inquire about the June 2023 promotion starting at 3,600 baht/day* from 1 - 30 June 2023 only."

So make sure that you plan your demise to be sometime in June.

 

As for if it were me, why string it out, As One More Farang said, have enough of the meds to see you through to the end, plus a nice bottle of something.

Have a peaceful trip  toast.

[Sheryl]

5 hours ago, toast1 said:

Sheryl & others

Thank you for your excellent advice.

Most useful.

 

I am in Palliative care now, its not so cheap, but I have found the doctors very helpful, with good English and an understanding of Living Wills etc.

Treatment has been efficient and reasonable.

 

There's Koon, Brumengrad, St Louis etc. in BKK, Koon being the cheapest.s

 

Though, what the add on costs will be, I don't know.

 

Cheers

 

 

 

 

 

 

 

 

 

 

Where are you being treated? And can you share doctor(s( names? For future reference.

[toast1]

I'm trying to not string it out, but as they can't practice euthanasia, its just a matter of avoiding pain through medication.

 

I've always been a believer in Euthanasia, but all I can do here is a Do Not Resuscitate form and a request to not receive medical treatment. 

 

 

 

thanks

 

[Sandboxer]

I only wish I will be as mentally strong as you obviously are when my time comes. Peaceful journey, friend. I'm an atheist but wishing for you I'm wrong.????