By Taido
It was my first visit to see L, a lady in her late 80s who had terminal lung cancer. At the door, I was received by her daughters, who promptly directed me to sit in the living room. This often happens when the family has some concern about the visit. I waited expectantly.
“We will appreciate if you do not talk with her about the cancer”, the elder daughter said emphatically.
I have heard such requests many times. Mostly, it comes from well-meaning family members who believe that revealing the cancer diagnosis would lead to some catastrophic outcomes, such as the patient losing the “will to live”, having an emotional meltdown, becoming depressed, or even dying quickly through some mystical or unknown mechanisms. Some family members would only permit the consultation if the doctor agrees to deceive the patient, while a few even threaten the doctor with complaints if they revealed the condition.
“So she does not know she had cancer?” I asked even though I believed many patients already knew or guessed it – many of them had consulted with a CANCER doctor, received CHEMOTHERAPY, stayed in a CANCER ward, and the more social ones may also have exchanged notes on their illness or treatment journeys with fellow CANCER patients while in the waiting areas or in the wards.
“Not exactly… she knows about the cancer… but we have not told her how serious it is,” she revealed.
Do patients NOT know how severe their illness is just because they are not told? Most patients can intuit how their body has changed, and together with the fact that they do not feel better after seeing multiple specialists and undergoing different treatments, it is usually not that difficult for them to join the dots.
“We know that it is important for her to know, but… I think she is not ready to know that she is dying”, she continued. It then transpired that L was an avid traveller, and had visited almost every continent before her illness. “Just yesterday, she was still talking about going on a plane trip!”
Wait, what? That put the brakes on my reverie about how this was to be another “regular” non-disclosure narrative – perhaps she might be one of the very few who are really not aware at all? I went on to suggest exploring with the patient what she already knows and how much she would be prepared to know. The family reluctantly agreed only after I assured that they can be there as I speak with her and that I will only explore what she was comfortable to reveal. We then trooped into her room.
On that occasion, L was in bed and surrounded by her grandchildren and helper. Clinically, she was frail and already breathing with some effort, even at rest; but socially, her demeanour was that of a doting and well-loved grandmother, with playful glint in her eyes. After the usual introduction and medical assessment, I managed to strike up a conversation about her travels.
“Ah Ma (granny) wants to go…”, she grinned cheekily while her flattened right palm swooped upwards like an airplane taking off.
“Oh, taking a plane trip! And where would you be going this time?” I decided to follow her flow. But for a moment, L seemed hesitant to reply. I repeated the question.
L put her index finger over her lips, like a little child guarding a secret. Her left hand again mimicked the plane take-off, only this time, it went even higher.
“Looks like the plane goes ALL THE WAY UP,” I followed her cue and went for broke, “… to heaven”.
Now L’s eyes lit and she was giggling as she nodded.
“You know, you don’t seem too worried about that,” I reflected back to her, in the hope that she will say more for the family audience.
“Ah Ma is old already. My time is short. All my children and even grandchildren are grown up. Some of my grandchildren have even gone to university. There is nothing to be worried about,” she explained, more sombrely now.
I have heard this aphorism uttered by so many seniors when they know they are dying. It may sound like a simplistic expression about life completion, but the attitude that underlies it has immeasurable weight: while many younger persons derive a sense of purpose and completion from personal achievements and attainments, these older folks are contented solely in the attainments of the next generation.
I glanced around the room: there was a muted sense of relief as well as some pairs of wet eyes. They got what she meant. But it was more than the family hearing her, for in that tender moment, they were all connected with each other in their true selves without the need for pretence, disavowal and isolation.
Sensing fear in her listeners, many doting elderlies chose to censor themselves or like L, give it a humorous twist, in the hope to convey what is acceptable rather than what is true. Surely, telling the truth about dying is painful, but what can open and touch the heart is also the truth. And it is only by addressing what is true of dying and death (even indirectly, like in L’s story) that one can begin to authentically speak to the healing “heart processes” – completion, reconciliation, forgiveness, resolutions, and assurances.
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 interest in end of life care.
