Letting Go Is Also Love: Limited Treatment, Devoted Care, More Companionship, Fewer Regrets

All along, there have always been patients with advanced or end-stage cancer and their families who place great hopes in me, hoping I can work a miracle for them.

Working miracles for patients is also my wish. I believe everyone who studies medicine sincerely hopes to work miracles for patients, while also gaining confidence and joy from helping them shake off disease.

But reality is always cruel. The vast majority of advanced cancer patients, especially end-stage ones, have no hope of being cured. Faced with the excessively high expectations of patients and their families, doctors are often intimidated, become extremely cautious, and dare not readily take such patients on.

Because treating such patients ends in failure the vast majority of the time, the doctor cannot fulfill the patient's and family's wishes, and continuing treatment leads to the family losing both their money and the patient. Medical disputes easily arise. So unless the patient is someone familiar, doctors are not very willing to take on such patients.

Each time I encounter such patients and families, I wish I had time for a heartfelt talk with them—to comfort them while also persuading them to lower their expectations and be more rational. They should not imagine medicine, still less me, as too miraculous. I have no power to raise the dead. Although I have occasionally cured a few patients successfully, there are also tens of millions of failures.

From a realistic standpoint, for advanced and end-stage patients, one should not pursue a cure, still less undertake too much treatment; rather, only limited treatment should be given. Devote more time, energy, and money to accompanying the patient through this last difficult stretch of life in relative comfort. The more the family accompanies the patient, the fewer regrets there will be later.

According to statistics from Singapore's medical institutions, the period when most patients spend the most in hospital is the last few months of their lives. The medical costs of these final months account for about 70–80% of a patient's lifetime total medical spending.

This is a rather unworthy trade: we spend a large sum of money to buy a few extra months of life—and in fact those months may not even have been won by the doctors; perhaps the patient would have lived those months anyway without treatment.

Some Japanese doctors have even reported that if the family provides adequate companionship and the patient is in good spirits, some advanced cancer patients, left untreated, can still gain a few months of life—and the effect of such companionship is even better than that of anticancer drugs.

Of course, providing an appropriate amount of treatment to relieve the patient's suffering greatly improves the quality of life of advanced cancer patients. Some patients, with the help of palliative care, can even live a good deal longer. But treating recklessly, regardless of the cost, only backfires.

Among the end-stage cancer patients I have treated so far, the one whose life was prolonged the longest lived eight years—a patient who was originally expected not to survive three months. Had this patient been given high-dose anticancer therapy instead of palliative care, he would have died long ago.

When a person is terminally ill and one still hopes to use high-dose anticancer drugs—whether Western or Chinese—to fight the cancer, that is very irrational. Because the patient is now frail, too much anticancer treatment only accelerates death.

Life has an end. Although different people take their leave of life in different ways, no one can escape death. For the vast majority of advanced or end-stage cancer patients, death from the cancer or its complications is already inevitable.

As Buddhism says, life has eight sufferings: birth, old age, illness, death, parting from the loved, meeting the hated, not getting what one seeks, and the flourishing of the five aggregates. When we must face our own death or the death of someone we love, our hearts suffer greatly.

With the progress of science and the development of medicine, humanity's understanding of cancer grows ever clearer. Cancer can not only be detected, but modern medical instruments can also tell us how far the cancer has progressed and how grave the threat to the patient's life has become. We must face the cold reality that the life of ourselves or our loved one has entered a countdown.

This is a life experience our ancestors never had. Although they might judge from life experience that someone was terminally ill, even so, because they lacked a clear sense of how far the disease had gone, they did not know as clearly that the patient was about to die, and could still harbor some illusions.

Illusion, though like a psychic anesthetic, can help people overcome the fear of death. People today must face a far crueler situation than the ancients: various instruments tell advanced or end-stage cancer patients and their families that the patient's days are numbered.

Being sentenced to death by doctors feels terrible, and the torment of illness is even more frightful than a real death sentence. Because before an actual execution arrives, the body need not suffer so much pain and torment.

Many advanced cancer patients, meanwhile, endure these final days in anguish from complications such as cancer pain, cancer fever, ascites, and pleural effusion.

Patients and their families must learn to face and accept reality, and learn to let go. In this situation, letting go is both an act of love and a more rational and more humane choice.

When patients and their families understand how to let go, medical staff will also be more willing to help them through this final difficult period—helping relieve the patient's suffering, helping the patient overcome the fear of death, and helping the family ease the intense pain of life-and-death separation.

Death is an eternal human theme, and living in the face of death is the real existential state of most advanced cancer patients.

If doctors and patients are to cooperate well in this stage against the threat of death, a tacit understanding must exist between them: the patient and family hold reasonable—not excessive—expectations, understand the disease objectively and rationally, trust the doctor firmly, and understand and accept the risks inherent in medicine. Only then will the doctor have no lingering fears and be willing to strive wholeheartedly yet relatively prudently for the patient's last chance.

If some patients and families are overly emotional, too desperate to survive, and hold expectations too high, the doctor will instinctively step back to protect themselves. I do not know how other doctors handle this; I myself will not take on any patient whose expectations are too high.

So patients or families who urgently demand a guarantee of treatment efficacy from the doctor should moderately rein in and control their emotions and face reality rationally; otherwise the doctor will recoil out of fear.

No one dares to bear a stranger's life-or-death responsibility. A human life is at stake; when a patient dies, family members turning on the doctor without a backward glance is something that has happened all too often. Solemn promises are less reliable than sound reason.

Few doctors will take huge risks for a little money to admit a patient who has lost their reason. Few doctors will drop their guard against the emotional reactions of patients' families. To have a long professional life, a doctor must have a strong sense of risk.

I often feel fortunate when I encounter a patient or family member who shows impatience even before treatment has begun. Because once a real doctor-patient relationship is established with such people, they become like a ticking time bomb—a nightmare the doctor will never forget.

Discovering their dangerousness before the doctor-patient relationship is established helps the doctor avoid risk. The family's feelings are understandable, but the doctor's safety matters too.

A person's cultivation cannot be feigned; every word and deed betrays them. As patients and families, it is very important to learn to seek medical care and interact with doctors in an objective, rational, and restrained way.

In this final stretch of life, finding a doctor who can cooperate well with the family will spare the patient much suffering and add many days to their life.

The laws of life and death that nature has set cannot be reversed by human effort. So for advanced cancer patients, the most rational and most rewarding choice is to follow nature, adjust their inner expectations, and seek moderate, reasonable, reliable, and sustainable medical help. Only thus will they avoid leaving too many regrets.