Quality of life to the chronically and critically ill

Within a fortnight, I lost 2 men I knew to heart attack and cancer. One was in his late forties while the other was in his early sixties. I regret not spending more time to know the latter for he was once my mentor and trainer when I started my career. His tall, confident and reassuring frame is etched vividly in my mind. In fact, his hyponasal voice rings in my ears as I write. It had been at least 2 years since I last saw him, so I cannot help thinking about him and how he had coped with his cancer and pain. He had managed to keep his illness a secret so well.

The man who suffered a heart attack was my girlfriend’s brother. I was invited to spend time alone with her elderly parents because they could not come to terms with his sudden departure. Their son left behind a widow and two teenage children. “Why did God take him away so suddenly?” her inconsolable father asked repeatedly. While we sought comfort in God’s promises by reading our Bible, we found ourselves discussing about the quality of life his son would have if he was still alive today.

How does one define ‘quality of life’? Let us refer to 2 definitions below:

  1. The general well-being of a person or society, defined in terms of health and happiness, rather than wealth.”

Source: The Collins Dictionary

2. Quality of life is multidimensional. Coverage may be categorised within five dimensions:

  • physical well-being
  • material well-being
  • social well-being
  • emotional well-being
  • development and activity

Source: Welsh Centre for Learning Disabilities Applied Research Unit, University of Wales College of Medicine

How one measures quality of life depends on his life circumstances and the roles that he plays in society. For a full-time housewife who is not expected to actively work to earn an income, having quality of life to her may mean having time alone to drink a cup of coffee and enjoy reading the newspapers at 3 p.m. daily, after she has completed the domestic chores, minded the children and prepared her meals. To a full-time breadwinner in the family, having quality of life may mean having the financial means, energy and stamina to engage in a sport or hobby he enjoys after work. To full-time students, it could mean having the time and permission from parents to play or to have a little more sleep.

But what does quality of life mean to a chronically ill and critically ill patient? We find this third definition from MedicineNet, Inc. most apt. It defines ‘quality of life’ as “the patient’s ability to enjoy normal life activities.” The Life Insurance Association defines these normal living activities as ‘Activities of Daily Living (ADLs)’ which are outlined in the table below.

Table 1: Activities of Daily Living (ADLs), Life Insurance Association Singapore

Normal life activities or ADLs include simple acts that healthy people typically take for granted. To illustrate, feeding includes one’s ability to lift up a spoon or hold a cup to feed himself. It includes one’s ability to hold food and fluids in the mouth, and to chew and swallow. Dressing includes one’s ability to button up, pull up a zip or put on socks and shoes. Toileting includes one’s ability to relieve his bowels without the help of others or that of diapers. Living normally involves more than one’s ability to walk and run. It means being able to speak, laugh and cry whenever one needs to and desires to. For the chronically and critically ill, living normally involves one’s ability to make simple day-to-day choices without aid or with as little aid as possible. For those who need aid, it involves grace, inner peace and harmony to accept help from others.

We don’t have straightforward answers as to why our dear friends and family are called home before our time. What we know is life on earth is never meant to be everlasting. Each of us has a biological clock and a purpose to live for. Respecting this clock involves loving and embracing life and our purpose in life to the best of our abilities.

Would my two friends be better off alive given their critical medical conditions? Knowing their persistence and perseverance, I am certain that they had both fought their best fight. It would have been very painful for them not to be able to fulfil their normal daily activities of living. By faith, I am confident they are now in a better place. We, who are living, must learn to let go and be grateful for our quality of life.

I miss you, guys.

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