My work in the intensive care unit in a busy public hospital allows me to share the sorrows and joys of my patients.

I would like to recount a very inspiring real-life story which I witnessed recently. Names have been changed, and details altered, to protect the privacy and confidentiality of the persons involved.

Benedict is a gentleman in his forties. He is single, and has lived separately from his siblings for many years. Recently, he was diagnosed with a brain tumour in a very critical part of the brain. He suffered intractable headaches. His neurosurgeon warned him that surgery would be very risky, and may leave him dead or paralyzed, but he chose to go ahead with it as his pain was unbearable.

“If I wake up paralyzed, do not then go to extraordinary lengths but let me die naturally,” he told the surgeon.

He underwent the surgery. The tumour was successfully and completely removed. The surgeon’s fear, however, also came true. Benedict was “locked-in”, due to infarcts in his brainstem. He could blink, gaze up and down, and manage half a smile, but nothing more. He could not move any other muscle. He had to remain on a breathing machine.

Initially, we tried every means to help him get better, but after some weeks, it became clear that he was likely to remain permanently “locked-in”. We were cognizant of his request, but as he was otherwise clinically stable, and not dying, we felt it was wrong to stop the breathing machine unless he expressly requested for that on the grounds that the burden of treatment was unbearable. We could communicate with him by a system of direct questioning, with him blinking once or twice. We decided to find out his true wishes.

He settled into a routine, watching DVDs on a portable player and listening to music. His family visited him. He was fed by a tube. He seemed happy and did not request to die again.

We discussed home discharge. Angel, his sister, decided to rise to the challenge. She resigned from her job, and employed a maid. Together with the maid, she learnt how to look after the tracheostomy (breathing tube), how to nurse, feed and change Benedict. With their commitment, they quickly acquired all the necessary skills to look after Benedict at home. Benedict’s two other brothers pledged to financially assist Angel and Benedict in the coming years.

During the first weeks at home, there were many challenges. Benedict developed recurrent episodes of blockage of his tracheostomy due to mucus plugging, and the physiotherapists, nurse and homecare doctors had to visit him frequently. These crises refined the skills and increased the confidence of Angel and her maid, and before we knew it, they had been settled at home smoothly for three months.

Benedict came back recently to ICU for a suspected lung infection. Apart from the respiratory secretions, he looked well. He had put on some weight, and there was a rosy hue to his cheeks.

I took the opportunity to review with Angel the situation, and to do advance planning for his care. We discussed if we should go on to invasive treatments such as inserting invasive cardiovascular monitoring instruments and using special medications. She said yes. I suggested that such treatments might prove to be futile, and that it might just be increasing his suffering.

She said, “He is happy now, and would want to live longer if that is possible”.

“Are you coping well looking after him?” I asked.

“Yes I am very happy,” she said with a firm tone and a genuine smile.

During my ward rounds, I observed their interactions. She would caress his forehead lovingly while talking to him; and he would flash to her his disarmingly charming half smile (he can only move one side of his face). She would joke with him, and he would smile broadly in response. All of us, doctors and nurses, were amazed and edified.

Many of us cannot imagine losing our health, or our ability to move or to talk. We instinctively think that to be happy, we must be healthy, beautiful and rich.

Thanks to Angel and Benedict, I have learnt that the formula for happiness is simple. Only one thing is necessary. Love. I have glimpsed a little corner of heaven!