by Taido
CL was a 66-year-old teacher assistant, who had advanced colon cancer that had spread to the liver and peritoneum (lining of the abdominal cavity). When she saw me at the clinic, she was already frail, weak and jaundiced. There had been pain over the abdomen but this had largely abated following commencement of opioid analgesics.
I had just settled CL at the treatment area when I found her husband, son and daughter still in the consultation room. They were keen to know about the prognosis because CL had told them that she will die in 7 days. “Did she explain how she knew it will be in a week?” I asked. After my encounter with Madam W some years ago, I try to make it a point to ask how some patients predict their deaths (See Madam W’s story in http://Ending notes –the appointment ).
“It’s her superstition that she will die within the Qing Ming period”, said her husband, rather dismissively. Coincidentally, that day was Qing Ming or the Chinese “Tomb Sweeping Day”, but the observance may take place over a period of about 10 days before and after this day.
“She also reported seeing ancestors”, her daughter added.
“Oh… what was that experience like for her?”, I asked. They looked at each other, stumped by the question. “Err… how do you ask such things?” her son eventually asked with a mixture of incredulity and the creeps. I suggested asking CL together as I sensed it might be useful for the family to know.
Back at the treatment area, CL casually confirmed seeing her ancestors. She denied she was fearful. “They were just standing there… Not doing anything in particular… They did not look wrathful or threatening… in fact, they looked… happy”. And no, they did not advise her about her prognosis.
There is a widely held belief that when a dying patient sees ancestors, death would be imminent. Some may ascribe these paranormal experiences – visitations by the dead loved ones, who may supposedly serve as guides to the afterlife. But psychologically, it is also not difficult to see the link between a patient who is living out a terminal condition and experiencing dying, and her having thoughts, dreams or visions about death or deceased loved ones.
Medically, such visions are often explained as hallucinatory experiences. When the person is critically ill and possibly close to death, delirium may supervene as the brain function falters from the dying or disease process. Impaired alertness, confusion and hallucinations are often symptoms associated with such “terminal delirium”. In line with this understanding, medications such as certain tranquilisers and sedatives can effectively eliminate these hallucinatory phenomena for patients who are distressed or agitated by them.
Yet, among those patients who are open to speak of such experiences, only a few reported it as eerie or terrifying. Some described the experience of meeting with ancestors, in this context, as neutral; but many more, like CL, related a sense of serenity, reassurance and love. Even among those who are spooked by it, the fear and anxiety seem more like afterthoughts of the experience rather than the actual experience itself.
CL’s family appeared more relieved now. Personally, I was still curious about how she predicted her time of death. CL explained: “Doctor, I know my body is changing. I can feel the energy fading and I think I will probably not last past the week.”
CL died at home, 8 days after that clinic visit. It was still within the Qing Ming period.
Ending Notes
The modern narrative on the end of life is often crowded and even fore-grounded by a profusion of medical details — of distressing symptoms, unrelenting diseases, futility and hopelessness. But the end of life is never merely a medical event; it is a human experience that reaffirms the inescapable human condition and what it means to really live, if only we choose to turn towards it. “Ending Notes” is a series of anecdotes depicting these human experiences, from which may be aspects that moves, inspires or edifies us about life. While the stories are based on true events, the characters and background have been fictionalised, so that any resemblance to real person(s) is purely coincidental and perhaps reflect how we can as easily identify with the human conditions portrayed.
Taido
Taido is a Family Physician with an interest in end-of-life care.
