Minor Illness Seeks Medicine, Major Illness Accepts Death; Incurable Illness Is Treated Gently

There is an old Chinese saying: "Minor illness seeks medicine, major illness accepts death." I would append a tail to this dog: "For incurable disease, treat gently."

Over my years studying Chinese and Western treatment of cancer, this saying has struck me deeply. I once saw a report in Singapore's Lianhe Zaobao citing medical statistics: while human life expectancy has risen in recent years, the added years are mostly spent in suffering. This holds in developed and developing countries alike.

I cared for my own ailing mother for years, and I know firsthand the quality of life after her illness. What tormented her most was not her cancer but the sequelae of a cerebral hemorrhage.

The stroke left my mother with hemisensory disturbance; every day she felt as though half her body were being roasted over a fire, worse on rainy days. I exhausted every Chinese and Western method; through our social connections we consulted doctors in the US, Germany, and Japan, yet could not relieve her suffering. The most effective measure turned out to be getting her to play cards—playing, she would forget.

Of course the forgetting was only temporary; when the weather changed she again wished she were dead. Several times my mother told me she wanted to kill herself to end the pain; as her son I of course tried hard to dissuade her. Once, walking with her by a river, she all but wailed that she did not want to live; I dropped to my knees and begged her not to take her own life.

Now, having witnessed many people's struggles against disease and suffering, I have grown increasingly detached about life and death. Looking back at my mother, I think that when she had the cerebral hemorrhage, our all-out rescue may not have been very rational. She was unconscious; had she simply passed then, she would have been spared so much suffering in this world.

When illness is at a hopeless stage, I have become disillusioned with both Chinese and Western medicine. Whichever system, help offered to a hopeless patient is limited, and the more one treats, the more suffering one may bring.

Personally, I think that when a patient has reached an incurable stage—terminal cancer, or critical illness with multiorgan failure—the best strategy is light treatment.

What does light treatment mean? Using simple treatment options that do little damage to the body, to moderately (note: not fully) relieve the patient's suffering. For such patients, pursuing a perfect cure is a wrong decision. To make such a patient entirely pain-free is a fantasy that defies reality; clinging to that fantasy in treatment will ultimately make the patient suffer from excessive medication.

I now spend much of my time in hospitals and patients' homes, providing end-of-life care to critically ill patients. In a few patients, startling miracles have indeed occurred, greatly extending their lives. But such low-probability events cannot be counted on; in most cases one can only relieve part of the suffering—giving appetite to those who cannot eat, ending pain in those who hurt, freeing those tormented by cancer fever, modestly extending life, and improving quality of life.

I rather fear encountering patients and families with excessively high expectations, and keep my distance from those who pursue "filial piety" at all costs or who are irrational.

I have a fellow townsman who got cancer, spent his entire fortune on treatment, then borrowed everywhere, spending nearly five million. He wrote his story tragically and went around fundraising. Frankly, I would not give him a cent. Partly because I am not well-off, but more because I felt he was irrational and selfish, giving little thought to whether his family could survive. Not long after dragging his family through misery, he died.

I have also seen hopeless patients desperately piling on medications, hoping to control their cancer cells. I fully understand their will to live, but unfortunately, doing so only backfires.

From my own experience, for patients with little therapeutic value left, using a few medications to relieve the relievable symptoms, leaving the unrelievable as they are, and improving quality of life is far more meaningful.

In this era of frequent medical disputes, I am personally very cautious and unwilling to join in all-out treatment. Because such treatment often means the family spends enormously only to end with both the person and the money gone, which easily spawns disputes.

When I worked in a hospital, my boss told me that, given Chinese attitudes toward death, even if I refused to give terminal patients all-out treatment, those patients would simply find another doctor and go bankrupt trying to be cured.

I now have more experience and recognize he was right. But even so, I still hold to my own principles.