The Meaning of Hospice Care

Qixi, also called the Qiqiao Festival, is in folklore the day the Cowherd and the Weaver Girl meet, and it was also my mother's birthday. My mother was born on the seventh day of the seventh lunar month in 1954; had she lived until today, she would be only 65. In modern society, 65 is not old. When she passed away, she had not yet reached 58 full years.

Once I grieved deeply over her premature death. More than seven years have passed now, and I have accepted this outcome, and feel that if I myself could leave this world before old age sets in, like my mother, it might not necessarily be a bad thing. At least I would not have to experience the helplessness of decrepit old age. It would be good to avoid the suffering of "old age" among the eight sufferings the Buddha spoke of.

So the fear I once felt toward cancer and other fatal diseases has now gradually faded. I have already lived to forty; in ancient times, most people did not reach forty, and those who did were the few. War and disease are the two great causes of human death. We live in a peaceful age, unscorched by the fires of war; to have lived past forty is already fortunate, and we need not crave to die without illness.

On this trip to Shaanxi, I took the opportunity to see a lung cancer patient in his seventies in Xi'an. The old man had already entered the end stage; because of overtreatment earlier, his body had been greatly damaged, and now his quality of life was very poor. When I got off the train, his daughter met me at the station, and I followed her to the patient's home.

Once at the patient's home, I saw that he was basically bedridden and extremely emaciated. I told the elderly patient very directly that I could not cure him, and that I had not come to cure him; rather, I hoped to provide him with hospice care before the end, so he would suffer less and leave with less pain. I told the old man not to harbor too many illusions about a cure.

Our conversation was frank and natural, and could even be called pleasant. The old man himself did not have much fear of death; it was his family who truly felt panic and anguish.

On the way over I had already spoken at length with the patient's daughter, telling her to be more philosophical about death and that there was no need to do too much futile treatment for her father. If she could relieve some of her father's suffering rather than pursue an unrealistic cure through too many traumatic treatments, then when her father finally passed away, she would feel much better in retrospect.

When we left the patient's home, the daughter came out with us. On the way, she said that on their long search for medical help they had never met a doctor who could tell them so frankly how to face death. She and her family had also never discussed his death so directly with the old man, nor discussed hospice care. My puncturing of that paper-thin barrier surprised her and yet she felt she had benefited greatly.

She asked me why I could face death so calmly and rationally—was it because I had seen so much life and death? Having seen much life and death is indeed part of the reason, but I think what really allows me to be detached about life and death is the books I have read and my own life experience, which has had little to do with death itself: having already lived vividly, why fear death whenever it comes? One should live as splendidly as summer flowers and die as quietly and beautifully as autumn leaves.

Death is a life theme no one can escape, but regrettably few people think rationally about it, because most people loathe death and clinging to life and fearing death is human nature. Yet no matter how much one fears death, it will come after all. In the face of death, escape and panic are useless.

If one day I must face death, what I truly need is not to fight death, but rather that my family lighten my physical and mental burden as much as possible, so that I need not leave this world amid physical torment and emotional anguish. I only hope that the people I love can give me natural, plain companionship before the end, rather than a struggle tangled with grief and panic.

Most of the time I am doing hospice care, because most of the patients who come to me are already terminally ill. As someone whose profession is caring for patients, what I need to consider for these dying patients is how, at the final moment of their lives, at a relatively low cost, to win for them the best possible quality of life, while moderately prolonging their survival with good quality—if staying alive is a torment to them, then there is no need to prolong it.

This requires the understanding and cooperation of the patient and family. If they cannot reach a consensus with me on the purpose of treatment, then such treatment will ultimately be abandoned halfway—either I give up midway, or they do. So I prefer frank, direct communication with patients and families rather than deception—whether well-intentioned or malicious.

So I always hope patients know the truth about their disease, rather than guessing in anxious turmoil. Many families hide the patient's condition from them, but they are unable to relieve the patient's physical suffering, which only leaves the patient tormented by guessing whether they are terminally ill; this guessing is actually more agonizing than knowing the true condition.

How to arrange these last days of life should most of all follow the patient's own wishes, not the family's. In all my life I have not seen a single person who does not long for independence and freedom; even if they deny it verbally, in their concrete actions they still defend their independence and freedom. Letting relatives decide a person's life and death and arrange their final days is against humanity and human nature.

Only after understanding these truths can we see the meaning of hospice care and truly bring the most valuable help to the patient.

Hospice care is not giving up; it is making a final, pragmatic effort. The meaning of life lies not in how long one lives, but in whether one was happy while alive. The purpose of studying medicine is not necessarily only to rescue the dying and heal the wounded; at the patient's final moment, relieving the patient's suffering as much as possible and comforting the family's grief is also where the doctor's value lies.