Home caring for the dying cannot be matched, Dr E V Rapiti, July 8, 2025, Cape Town

Dr Rapiti writes about his experience treating a terminally ill patient at home as an advocate of family medicine.

Dr Rapiti shares his experience treating a terminally ill patient at home as a firm advocate of family medicine.

"The unexpected exposure to life’s harsh realities—and the agonising encounters with ugly people—saps us of our precious energy. Only the tranquilising healing combination of time, patience, therapy, and the emergence of brighter experiences will contain, destroy, and banish the pain that mercilessly consumes our body, mind, and soul like a relentless cancer, finally relegating it to the quiet and peaceful, forgotten archives of the mind".

—July 9, 2025

This meme was written for a caring daughter who lost her dad after he fought a battle against cancer and won but succumbed to chronic obstructive airways disease. I was privileged to be intimately involved in the management of her dad's entire illness.

The daughter called me out of desperation for help, not knowing what was wrong with her dad, who suddenly became ill. I ordered a scan of the, made the diagnosis of cancer to the right lung with secondaries to the liver. I gently broke the news to the daughter and her father. Upon her implicit request to treat her dad with alternative medicines, because she and her dad were vehemently opposed to chemotherapy and radiotherapy, I commenced treatment immediately with a range of repurposed medications, supplements and home oxygen.

He responded well. After a few weeks of aggressive treatment, his health improved remarkably.

He was able to get out of bed, stroll down to the beach, feel the breeze on his smiling face, and savour the little pleasures of life—moments that meant everything to him and his daughter.

Her implicit faith in me as primary care physician, without requesting any intervention from any specialist, placed a huge burden of responsibility on my shoulders and at the same time revived the forgotten role of primary care physicians in treating the terminally ill in the comfort of their homes. It was reminiscent of my experiences during COVID, when I successfully treated very ill patients at home.

My task was made easy by the excellent cooperation from the daughter, who was willing to discuss and try the various approaches to help her dad recover. We were a telephone call away from each other, whenever the need arose.

The daughter converted the dad's room into a high-class ICU, with an oxygen tank, a range of alternative medications and supplements and an oximeter.

I was given regular updates to monitor her dad's progress and response to treatment.

Dad's health suddenly declines

Her dad's improving health, after three months of treatment, suddenly declined in the last three weeks due to unstoppable muscle weight loss and an inability to expel the copious amounts of phlegm due to his chronic obstructive disease, brought on by years of heavy smoking.

The daughter gracefully summoned up all her resources of love, compassion and caring to buoy her dad's sagging spirits when all hope of reversing his condition failed.

I shared her spirit of giving hope to her dad even though we both knew that we were fighting a losing battle. His stoic smile in his final days, was a mark of a strong man willing to face the blows that life threw at him.

Called to see him the day before he died

I was called out to see him a day before he passed away. He was going rapidly downhill but acknowledged my presence with a gentle smile. His mouth was too dry to speak. I reassured him with a gentle touch and sat by his bedside and chatted with his daughter for him to hear my reassuring presence.

Gave him hope

I communicated with him with a cheerful greeting and told him how well he looked as I always did with the dying patients in my practice. I felt it is best for the dying to leave with hope in their hearts and minds than to let them depart miserably with despair, pain and in agony.

I received a message 36 hours after my last visit from his very emotional daughter informing me that her dad had quietly passed away quietly after he gently slipped into a coma.

I felt a pang of shock and sadness for the daughter, who expressed her gratitude for the help she received through the entire process with her voice breaking down. Her sense of loss was palpable and stuck in my mind.

I too wanted to save her dad. I took comfort in the fact that after we treated his cancer very aggressively, he managed to get out of bed and go to the beach and enjoy a month with his daughter feeling revived and enjoying nature again.

Doctors have their limits

Long years of experience have taught me asca doctor to accept my limitations when it comes to dealing with life and death issues. When human beings fail, it's up to nature to take over the reigns of our destiny.

When I reflect upon this experience and many other similar experiences, I remain unshakably convinced that the best place for the dying to spend their final days on earth is in the comfort of their home, surrounded by loving family members around the clock.

The dying in the final days feel insecure and too weak to ask for a drop of water or a bedpan, if left alone. When family members are close by, the dying feel a sense of comfort that human help is at hand.

Five star frail care centres,- just trimming

Contrast this with five-star frail care centres. One nurse has to care for about five very ill patients. Her connection to her patients is clinical unlike the connection that the dying have with their families. They cannot provide the care family and home carers can offer the terminally ill in the comfort of their homes.

Home care still the best

Home nursing and caring is so much cheaper and so much more effective than being in a fancy frail care centre, yet so many wealthy families choose frail care centres with detachment and convenience. Many die lonely and sad without the opportunity to say their last good byes. This was so prevalent during COVID.

Medicines and sophisticated care have a limited role for the terminally ill. They need lots of love and care.

The terminally ill lose their appetite to be tempted to eat five-star meals. What they need in their final days is lots of love, caring and support and the comfort of knowing that they are not alone and abandoned but in the hands of their loving families, children and grandchildren.

I salute the daughter, with whom I have built an affectionate bond over the past three months.

I was touched by the confidence she had in me. It came at a time when the world, after COVID, lost all faith and trust in the medical profession.

I hope that this story will encourage budding family doctors not to lose hope and regain the lost respect of the public in the medical profession by breaking the shackles imposed upon them by big corporate businesses, medical aids, hospitals and the condescending attitude of the arrogant specialists in their midst.

The difference between family physicians and specialists

The difference between family physicians and specialists is: specialists look at charts, machines, results and give instructions to the nurses with little consideration to the patients in front of them as they go about their hurried ward rounds; family physicians, on the other hand focus on their patients, listen to them and their families without paying too much attention to charts.

What the family physician delivers or can deliver describes the art and soul of medicine, which has been sorely destroyed by the ruthless takeover of healthcare and the medical profession by corporate businesses, medical aid and money-orientated hospitals where money and numbers count more than people.

We must never trade our values for anything

Finally, nothing in life would be totally lost if we find the will and determination to regain what we have lost.

We can lose everything and life will go on but if we lose our values, then there will be nothing worth left fighting for.

Dr EV RAPITI

Cape Town

July 9, 2025

Dr Rapiti is a family physician working in the poor suburb of Mitchells Plain Cape Town for almost 43 years. He has a keen interest interest in holistic and lifestyle medicine as well as addiction, women's, men's health and mental health. He is the author of a self-help book on addiction and busy on article about his experiences treating patients with COVID with a 99.98% success rate. robertrapiti@gmail.com, www.drrapiti.com