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Microsoft word - mastering_tasks_of_adolescence.docCASE REPORT
MASTERING TASKS OF ADOLESCENCE: THE KEY TO OPTIMUM END -OF-
LIFE CARE OF AN ADOLESCENT DYING OF CANCER.
Suriati Mohamed Saini* and Susan Mooi KoonTan.* *Department of Psychiatry, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latif, Abstract
Objective: This case report highlights the optimum end-of-life care of an adolescent dying of
cancer. Method: We report our experience, as part of a multidisciplinary team in managing
the cancers of a female student who died an untimely death at the age of 15. Results: Our
role of motivating her for chemotherapy of her initial treatable carcinoma, became that of
palliative care upon discovery of a second malignancy. We helped the patient “live life to the
fullest” during her last days, she helped us realize that helping her master the tasks of
adolescence was optimum “end-of-life care” as well. Conclusion: to help an ill adolescent
die with dignity is to help her live whatever time she has left of her life. Allowing her to
participate in decisions regarding her treatment and in other bio-psycho-social needs of that
stage of life is crucial in helping her prepare for the end of life. ASEAN Journal of
Psychiatry, Vol.12(1), Jan – June 2011: XXX.
Keywords: Adolescence, mastery of adolescent tasks, end-of-life care, death and dying.
helping the seriously ill adolescent master her tasks of adolescence optimally, can we help her accept and cope with the impact demonstrates that the Crude Incidence of of serious illness and its potential physical and psychological disfiguring treatment, and (ii) that accurate, honest and sensitive family plays a pivotal role to achieve this Case report
Z was a 15 year-old girl diagnosed to have ovarian carcinoma stage IV, of the juvenile medical treatment are played out against a with liver and bone metastases. She had a areas of the gastrointestinal tract. She The objectives of this case report are to Etoposide, Cisplatin regime) after just 1 cycle done and was referred to child and adolescent psychiatry because she was lost primary team broke the bad news to Z and her motivation to undergo treatment. This was because she could not tolerate the pain outcomes of each choice. Z did not speak resulted in her perception that she had lost but she understood all that was discussed. her femininity. Alopecia side effects of expressed interest in visiting the stadium image. She had persistent depressed mood, anhedonia, poor appetite and death wishes. She believed all cancer patients would die. This was reinforced by dreams of her aunt who had died of cancer, wanting to 'take condition, she declined. She was still able her away'. Premorbidly, she was a shy girl chocolates, something the family did not discharged and three weeks after discharge the family called up to inform us that Z had breathed her last, lying on her sister's illustrated books which taught relaxation. Discussion
She was happy to start chemotherapy after we had explained the process of treatment sports competition but the goal of 'going children aged 9 and above can understand cancer cells'. Local anaesthetic applied universal and inevitable. Adolescents physiological, psychological, and religious possible cosmetic use of a wig for alopecia consideration particularly when death from disease is likely. The primary challenges are (i) the achievement of biological and The course of events changed drastically sexual maturation, ( ii) the development of when she noticed a breast lump after one personal identity, (iii) the development of showed infiltrative ductal carcinoma stage appropriate peer, and (iv) establishment of independence and autonomy in the context chances of response to active treatment of The ultimate goal in discussing death with going to continue to live and grow up.for alleviate any fears. Katz  has listed References
three inter-related principles for good end- of-life care (i) to enable the dying person to die with dignity, (ii) to retain the dying person in his/her familiar surroundings till religious belief and cultural practices, it is necessary to prepare them spiritually for the final everlasting place. This way he/she will be able to avoid bewilderment and the fear of an early death and leaving loved ones. 3. Nagy M. "The Child's View of Death." treatment can be facilitated when the patient’s parents or next of kin and 4. Gaffney DA. The seasons of grief. New physician actively advocate the patient’s accurately, frequently and openly. In Z’s 5. Katz J. Managing dying residents. In: case, the patient chose to go home and she Katz JS, Peace S, editors. End of life in died surrounded by her family in minimal care homes—a palliative care approach. 6. Faull C & Woof R. Palliative care: an family are crucial to facilitate good quality of end-of-life care of a dying adolescent. http://www.pediatrics.org/cgi/content/full/ Paradoxically, quality end-of-life care of a dying adolescent is to help her master her tasks of adolescence optimally; as if she is
Corresponding author: Suriati Mohammed Saini, Lecturer, Department of Psychiatry,
Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000, Cheras,
Received: 10 January 2011 Accepted: 21 February 2011
Robert H. Keller, MD, MS, FACP, AAHIVS • Education and Training • Professional and Faculty Positions • Hospital Staff Appointments • Fellowships and Awards • Grant Support During Academic Tenure • Honors • Invited Lectureships • Editorial Boards / Reviews • Consultantships • Current Medical Licensure • Certification • Professi