Mr Mark Gabriel with his late wife, Agnes.PHOTO: COURTESY OF MARK GABRIEL
Mr Mark Gabriel lost his wife Agnes, 47, to a rare form of cancer last year, just over a year after his mother died from ovarian cancer.
On Dec 31, 2019, Agnes found out that her nasal cancer had recurred and then, in the middle of last year, she was diagnosed with stage 4 sarcoma - a cancer that begins in the bone and soft tissue. She was first diagnosed with nasal cancer in 2005, a year and a half after she got married.
Agnes spent the last six weeks of her life at Assisi Hospice. It was not as if she or her husband had planned for this change though there had been brief discussions between them on the difficult topic of palliative care. "We kind of danced around the issue..," said Mr Gabriel, 45, a Singaporean.
He is director and senior teacher at Julia Gabriel Centre, which was founded in 1990 by his mother, a British national and Singapore permanent resident, who died in in mid-2019.
In September last year, Agnes was still being cared for at home, a Housing Board flat.
Seeing that she was growing weaker, her husband bought mobility aids such as a wheelchair and a walker as well as a commode. He also bought a new bed, which was lower, so it would be easier for her to get into it. But, almost as soon as he got the bed, she suffered a hip fracture, and never returned to the flat that the couple bought in 2011.
"It wasn't even a fall. She was in bed and was trying to manoeuvre in and out of some clothes and just twisted her hip too far and it fractured," he said.
"Her bones had become that fragile at that point but essentially, the hip bone in the hip socket, the part that holds the leg into the hip bone, separated from the rest of the thigh bone. There were tumours growing in the hip socket."
After the hip fracture, the couple knew the hospice would be the best place for her. Nevertheless, they struggled with the idea at first, as they felt powerless.
"I think the initial sense is that when you move to palliative care, you've effectively decided that you're not going to try and fight the disease any more, but just allow it to take its course and be as comfortable as possible in the process and make the best of the time you have left," he said.
"That's a difficult thing to deal with, both intellectually and emotionally but it is something that needs to be dealt with..."
It was doubly hard for Mr Gabriel, as he had just lost his mother, a well-known figure in early childhood education.
Before her death, for two years, his mother, Julia, was in and out of hospital, staying for several weeks, he said. She always returned home, living fairly independently with a helper at hand for a few months.
His mother was adamant about not wanting palliative care.
"When she met her doctors, up until her final few days, what she wanted to discuss with them was ways of trying to fight the disease and ways to prolong her life rather than ways to allow her to be more comfortable while accepting that no way to cure her condition could be found," Mr Gabriel told The Straits Times.
"Only at the point in time when it became clear that all possible treatment options had been exhausted, did she become open to palliative care, and in her case that turned out to be about three weeks before she passed away."
The late Agnes Gabriel stayed in Assisi Hospice during the last six weeks of her life. PHOTO: COURTESY OF MARK GABRIEL
His late wife understood that it made sense to be cared for by specialists as she was in pain and knew that she was not going to walk again and that it would be hard to be cared for in a home environment.
In the end, the hospice care helped her a lot, he said. "Palliative care is partly about pain management as well, as a hip fracture is an extremely painful injury, and makes it very difficult to move around without causing further pain or further damage," said Mr Gabriel.
"Then, as the disease progresses... tumours grow and start to push on various organs."
"It's also just the sense that you're working with a team of professionals who really want to make those last weeks as comfortable as possible and have an opportunity for the family and the individual to have that time together," he said.
Agnes went for physical therapy, art therapy and music therapy and more.
Mr Mark Gabriel at his flat on March 22, 2021, with a painting his wife made during her time in palliative care. ST PHOTO: YONG LI XUAN
Professor Ivy Ng, SingHealth's group chief executive, who was the guest of honour at a palliative care forum on Tuesday (March 23) to launch a virtual palliative care centre, mentioned Agnes in her speech, saying she also received support to boost her emotional and psychological well-being.
"We're not just looking at life prolongation of curative means, but giving patients what matters to them during their final days, and giving them a good closure," she said.
Agnes did various pieces of art, including a bright and colourful painting of two deer, and the music therapist helped her plan some things for her funeral service, including a song that they helped her compose, said Mr Gabriel.
"These were things that gave us something positive to focus on and allowed her to have some sense of closure."
Agnes died at Assisi Hospice on Nov 17, nearly 11 months after her cancer recurred.
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