The patient visit turned out to be a family meeting. The daughter of the 90-year old patient had called and asked Dr Choo Wei Chieh to come urgently, briefly mentioning her sister was visiting. When he arrived, he quickly grasped the situation. She didn't need him to see her mother as much as she needed him to speak to her sister.
"How is she? Should we take her to the hospital?" the visiting sister spared no time to ask after Dr Choo finished his examination of their mother. "She's getting weaker because she's not eating. Hospitals have nurses and proper equipment, surely they can do something!"
The daughter who had summoned Dr Choo sat at a distance, looking tired but resolute. As the primary caregiver, she had witnessed her mother's gradual decline over weeks, understanding it as the slow, inevitable retreat from life that comes with advanced age and terminal illness. But to the visiting sister, this looked like neglect.
Dr Choo has been making house calls for nearly two decades in Singapore, providing both GP services and palliative care. The scenario wasn't new to him. The patient's conditions may be different, but the fundamental question families have to wrestle with is similar - Which care option is best for my loved one: home, hospital, or hospice? Home feels loving but inadequate. Hospital is professional but restrictive. And when hospice is an option, it requires an acknowledgement not every family member is prepared to face.
"Let me explain what's actually happening here," Dr Choo said gently to both sisters, "and then we can talk about what would truly be best for your mother."
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Sometimes Love Looks a Lot Like Disagreement
With his characteristic calm and empathetic manner, Dr Choo began explaining the natural dying process to the family. Reduced appetite and fluid intake are not signs that their mother was not being properly fed, they are the body's way of preparing to let go. Their mother's organs were already showing signs of failure. She had even stopped smoking weeks earlier, which was the first sign that something serious was changing, since she had been a lifelong smoker.
The hospital could intervene with IV fluids and medications, but these might not benefit someone whose body was naturally shutting down. In fact, forcing fluids into failing organs could increase discomfort rather than provide relief.
He helped the sisters understand that "better care" didn't automatically mean more medical interventions. At home, their mother had her daughters and a helper providing round-the-clock care, which is a "luxury" compared to hospitals where one nurse manages multiple patients. Hospital care would also mean removing her from familiar surroundings and limiting precious family time during her final days.
The visiting sister's perspective shifted as she absorbed this information. The family reached consensus quickly after Dr Choo left, which was not a moment too soon. Their mother passed away that same day, peacefully at home, surrounded by her family.
"Families don't always agree," Dr Choo reflects, "but I have come to understand, this disagreement often stems from the same love and desire to do more for their loved ones."
When it comes to end-of-life care, love manifests differently among family members - the daily caregiver vs the occasional visitor, the person ready to let go vs the one still fighting, the family member who wants "everything done" vs the one advocating for comfort care. These aren't conflicts between people who care more or less, they are different expressions of the same love and grief.
" Sometimes this means helping families understand that continuing aggressive treatment isn't necessarily the most loving choice. Other times, it means supporting a family's decision to try every possible intervention, even if the outcome seems unlikely. The key is ensuring that everyone - including the patient when possible - receives sufficient information to make informed, and ideally united, decisions."
Physical Pain is Just One Type of Suffering
Pain during final days can be a profound distress not just for the patient, but also for families witnessing it. Dr Choo Wei Chieh frequently fields questions about end-of-life pain. "Why does pain sometimes become so severe that even gentle touch becomes unbearable?" asked Angjolie Mei, who interviewed Dr Choo in a podcast. "It's devastating to see them hurting. But the helplessness of standing there, unable to offer relief, can be equally agonizing," she shared.
"At the end of life, when the systems are shutting down, there can be many kinds of abnormalities," he explained. "Electrolytes can be upset, there can be high calcium levels, muscle breakdown, poor circulation, all of these can cause physical pain. This is where medical intervention can help. It is the whole idea behind palliative care actually - to provide relief of pain."
The medical toolkit for managing physical pain has grown sophisticated. "We have patches, injections, and other pain medications that can be given when patients can't take medications orally," Dr Choo noted. The goal isn't to make someone "happy" in the face of death - that's often impossible - but to ease the physical burden.
Dr Choo has also encountered a different kind of suffering that's harder to address with medication. "There can be minimal physical pain but a lot of emotional suffering," he observes. "For example, patients haven't been touched but they shout. That's the mental component, it goes deeper than physical pain. There can be anxiety, fear, unfinished business, worries about family members they'd be leaving behind, or spiritual questions about what comes next."
"In these situations, being present is the best thing you can do," Dr Choo advised. "Your family's presence, talking to them, even when they can't respond, that kind of emotional support is actually the best medicine for this type of suffering."
His recommendation is to delegate each type of suffering to the appropriate specialist. Medical doctors address physical pain, counselors handle emotional distress, and religious leaders provide spiritual comfort. This multi-faceted understanding has convinced him that the "best" care at the end of life isn't necessarily the most high-tech type. It is care that addresses the whole person - body, mind, and spirit.
This is why palliative care operates as a multidisciplinary field. The palliative care physician doesn't personally provide every type of intervention, but they recognize diverse care needs in their patients and can guide the families to the appropriate resources. The key, Dr Choo emphasizes, is knowing that pain and suffering can be relieved, and asking for help when you need it.
'So Suay' Isn't the End of the Conversation, It's the Beginning of a Gentler One
In Singapore culture, death and end-of-life matters remain a 'pantang', or taboo, to talk about. People say 'so suay' (unlucky) when the topic is brought up.
"Even for me as a professional, it is not an easy conversation", Dr Choo Wei Chieh admits. "But I have learnt that the best way to support a family is to be upfront about it and tell them the truth about their loved one's condition. That gives them time to prepare for when the time comes. But it doesn't mean you can do so in an insensitive way."
For families, Dr Choo advocates an "early and gentle" approach. If possible, introduce Advance Care Planning (ACP) conversations while elderly parents remain healthy. Waiting until ACP is needed often means it is too late for a meaningful discussion, if that is possible at all. For readers who are parents of adult children and feel ready to engage, it can be tremendously helpful to initiate the conversation yourself. Children often struggle to broach the subject first, some may feel doing so is unfilial or disrespectful to their living parents.
When discussing end-of-life wishes with a parent facing terminal illness, Dr Choo recommends a careful probing technique: "Find out what they already know and what they want to know before going further." This was echoed by Angjolie Mei in her interview with Dr Choo.
If a loved one responds to your gentle probing with, "I know I've got something serious, but I don't know what it is, I know it's quite bad", that signals they're ready for more information. But if they say, "I don't know, I'm feeling quite okay," then respect that boundary. They may genuinely not want to know more at that moment.
You can be creative with how you ask. Let's say you aren't sure what color your mother prefers, you can bring flowers during a hospital visit and ask, "Ma, do you like this color?" See how she responds and what doors that might open.
Conversation techniques aside, Dr Choo acknowledges the delicate balance required for such a sensitive topic. "There's significant sensitivity involved, and perhaps some guesswork too. Pantang doesn't make family conversations easier, but it represents a part of your loved one's deeply held belief system. That deserves respect alongside their other end-of-life wishes."
The goal isn't to eliminate cultural taboos but to navigate them thoughtfully, finding ways to honor both tradition and the practical need for end-of-life planning.
How to Get the "Best Care" for a Loved One
After almost two decades of helping families navigate end-of-life decisions, Dr Choo Wei Chieh has learned that "best care" can't be defined by medical textbooks. It is deeply personal and dependent on each family's unique circumstances.
"Many families believe hospital care is automatically better care," he observes. "But when you look at the reality - being removed from the familiar home environment, one nurse attending to many patients versus dedicated care for just your loved one at home, limited family visiting hours - hospital care can create more stress than comfort for some patients."
But despite being a home care doctor, Dr Choo is realistic about the limitations of home care. "Sometimes families really can't handle it, and that's okay. They may have other obligations, feel too stressed, or the medical needs become too complex. In those cases, inpatient hospice care might be the better option." The key is matching the level of care to both the patient's needs and the family's capacity.
This is where his role becomes less about medical advice and more about helping families understand their options. "I can explain the medical aspects - what is my honest assessment of their loved one's condition, how pain and symptoms can be managed, what palliative care can provide in different settings and so on. But the decision? That belongs to the family."
What makes care "best" isn't the setting - home, hospital or hospice. It is whether everyone involved understands what's happening and what to expect with each option. "There's no universal 'right' answer," he concludes. "There's only what is right for this patient, this family, in this situation, at this moment in time."
When The Time Comes
Dr Choo has signed multiple certificates of cause of death (CCOD) for patients passing away at home and witnessed the full spectrum of family responses to loss over the years. What strikes him most is how the manifestation of grief has evolved.
"Fifteen years ago, when I arrived to complete death certificates, I regularly encountered families in acute distress - inconsolable crying, overwhelming sadness, and complete bewilderment about what to do next," he recalls. "Today, grief is still profound, but I see far less of that desperate, panicked distress."
He attributes this transformation to Singapore's improved hospice and palliative care infrastructure. Families now receive better preparation for what lies ahead, understanding both the dying process and the practical steps that follow.
"When families feel supported throughout the journey, when they understand what's happening and believe they've provided the best possible comfort for their loved one, grief takes on a different tone," Dr Choo observes. "It is still there, but it's not the same overwhelming despair arising from feeling unprepared or helpless. A lot of people in Singapore have come to accept that death is a fact of life."
However, he has noticed that acceptance of death varies dramatically depending on the patient's age and circumstances. "The elderly - and nowadays with Singapore's increasing longevity, that means 90 and above - often show a remarkable readiness for death," he explains. "They have lived full lives, witnessed children and grandchildren growing up, and even friends and siblings pass away. Many express genuine acceptance, comfortable with whatever comes next. For them, death feels like a natural conclusion rather than a premature interruption."
"But working with younger patients - those in their 40s, 50s, and 60s, facing terminal cancer for example - is an entirely different challenge," Dr Choo admits. "Frankly, I find these cases more emotionally difficult because there's still so much unlived life ahead of them. Their careers remain unfinished, children ungrown, dreams unrealized. It is heartbreaking to witness."
This understanding has shaped his approach to different families. With elderly patients, conversations often focus on comfort, dignity, and peaceful closure. With younger patients, discussions may involve legacy planning, family preparation, and sometimes the harder work of helping someone say goodbye before they feel ready.
Takeaway Message
Over the years, Dr Choo has come to appreciate that there is no perfect way to navigate end-of-life decisions. Home, hospice, or hospital, each choice has trade-offs. What is best for one patient and their family might not suit another, or might not even look 'best' to a member of the same family who has a different perspective.
What matters most is that the choice aligns with the values and wishes of the patient and family, and that everyone involved feels supported throughout the process. "In the face of death, love and care can find expressions in different ways. And sometimes," Dr Choo concludes, "it is enough."
About Dr Choo Wei Chieh
Dr Choo Wei Chieh has dedicated his career to bringing healthcare directly to patients' homes since 2006, providing comprehensive care including acute treatment, post-discharge recovery, long-term management, and palliative care.
He has been known affectionately as the "Doctor On Wheels," and in the last 8 years as the co-founder of Ninkatec, a home care provider committed to delivering quality healthcare in Singapore. At Ninkatec, in addition to his role as a medical doctor, Dr Choo leads a multidisciplinary team of doctors, nurses, professional caregivers, and allied healthcare professionals. Together, they bridge contemporary medical care with traditional bedside manner, ensuring patients receive both advanced medical care and genuine human compassion in the comfort of their own homes.
Learn more about Ninkatec's home care services including:
- Housecall doctors
- Nurse home visits
- Palliative care at home
- Mental assessment at home
- Specialised eldercare at home for seniors with dementia, stroke, or in need of transitional care
Or drop us a message to know more.
This article is adapted from an interview of Dr Choo Wei Chieh with Angolie Mei. You can catch the full interview on the YouTube channel "Dying to Meet You", or watch highlights on Ninkatec's YouTube channel.
