By Taido
I arrived at G’s apartment earlier than expected and was invited by her daughter to wait at the living room. Her daughter revealed that she was taking a shower and will take some time to make herself “presentable” for guests. Knowing G, who was in her 70s, looking “presentable” was nothing about obsessive vanity but rather, it is a custom of self-respect and a respect for others.
“Is it going to be too breathless for her?” I enquired, knowing that she had been having breathing difficulties. Shrugging her shoulder, her daughter replied that she was concerned as well but that’s just what G wanted to do.
G had been diagnosed with cancer of the womb two years ago and it had now spread to the lungs, hip and lymph nodes. The bulky lymph nodes at the neck had pushed the windpipe to the side, threatening to constrict it. She had recently completed a course of radiation treatment but that did not seem to stem the growth of the cancer at the neck. This and the extensive disease in the lungs were the reasons she had become increasingly breathless.
After half an hour, G was ready to meet me. Despite the laboured breathing, G was her usual relaxed, pleasant, and dignified self. I wanted to know how she had been spending her time.
“Oh, we went to the beach yesterday!”, she exclaimed gleefully in raspy voice that was hoarsened by disease. I reacted with a mixture of polite disbelief and suppressed alarm. But she whipped out her mobile phone, and showed pictures taken of her being flanked by her grandkids at the beach. Without the close-up details, one could not have guessed that she was actually so ill – it looked just like a happy family holiday photo. “I just wanted to feel the sand in my feet… I have not done that for a long time”, she explained. Nevertheless, she admitted that she was quite breathless while walking, though the morphine syrup was able to bring her some relief.
While G appeared to be coping remarkably well with her condition, she had her share of asking “Why me? I did not do anything wrong” when she found out that the condition was incurable. But she seemed to have put any semblance of self-pity behind her now. And even though she had become so much weaker and breathless, she was adamant about staying at home. And G had all the reasons to do so: G grew up in very humble and traditional family circumstances where being a female child, she had to give up her primary school education to work. While she held various cleaning jobs and her late husband was a driver, providing a good education for their children, regardless of their gender, became her cornerstone project. Perhaps not coincidentally, all her children, 2 girls and a boy now worked in various teaching professions. G had previously declared her pride and appreciation for their achievements as well as their filial piety. When the grandkids came, G was also there to help with their care. Now teenagers, the grandkids could be seen rallying around grandma, even while their peers may be gallivanting at the malls. Home and the family had always been the wellsprings of G’s joy and purpose in life.
But looking at her condition, G’s time would be regrettably short. The compelling medical reality reinstated its grim perspective: what could be done now was just to minimise the breathlessness, knowing that at some dreaded point, the airway can be so constricted that she will die from the inability to breath.
It was therefore not so unexpected when the next evening, I received an urgent call from her son because G “cannot breathe”. When I arrived, she was already unresponsive and very close to death. And then, what had happened unfolded. After I left the previous morning, G went on with her plans to meet with old friends and relatives in the afternoon. In the evening, she went out for dinner with her family. This morning, she woke up and decided to “treat the family to breakfast”. Halfway into the journey, she was already breathing laboriously. The family suggested calling it off. “No, carry on”, she insisted. By the end of the trip, she was understandably exhausted, and her fingers were noted to have turned blue. Upon her return home, the family put her back on oxygen, which seemed to settle her a bit. Then, there was another round of visitors in the early afternoon. After that, G finally decided to nap. It was a couple of hours later that the family realised she was gasping. She took her last breath a short while after I saw her.
One may wonder if G had pushed herself too much, eventually to the brink of her collapse. Yet, there are also many patients and families who stave off doing what they need to do for fear of potentially aggravating their condition, even when they are not dying. At the end, one may surmise that knowing how much family mattered to G, to miss that last opportunity to have the gathering or meal or a treat for the family would simply be unthinkable. For her family, holding back just wasn’t an option.
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.
