Signs of Approaching Death and the Passing of Cancer Patients

Most cancer patients inevitably die of their cancer in the end. Modern people have less and less experience in coping with death, so that many families are at a loss as the patient approaches death, and a few families cannot accept the reality that the patient is about to pass away and still resort to desperate rescue efforts.

Their feelings are pitiable, but their behavior is unreasonable.

When a patient is about to die, a series of signs appear. On seeing these signs, the family should do their best to prepare the final arrangements for the patient rather than blindly carrying on with rescue efforts.

In modern society many people ultimately take their leave of the world in hospital, and their last moments are spent being 'rescued.' Many obituaries of the deceased read 'died of illness despite treatment'; such an attitude toward death is not advisable.

Birth, aging, illness, and death are the normal laws of nature, and a rational attitude toward death is one of the required courses in everyone's life. In the past most people died in their own beds at home. In modern society people are accustomed to handing over the last few dozen days of their loved ones to the hospital. As a result, most patients, in the final few dozen days of life, spend more than half of their total lifetime medical expenses.

The function of hospitals ought to be to treat the sick, but now the hospital's functions are expanding without limit; handling the bereaved has also become the daily work of doctors, which has planted a great hidden risk of doctor-patient disputes.

As far as I know, most front-line clinicians are unwilling to risk doctor-patient disputes by carrying out end-of-life treatment. They would rather the families be more rational and handle the patient's death themselves, rather than end up with the family losing both the person and their money. Because at such a final moment, what a doctor can do is very limited.

Hospitals charge expensive fees for hospice care, yet cannot bring the patient much real help; the patient must, in these final days, lie in a ward lacking family affection and personal freedom. For the patient himself, this is not the best choice.

A better choice may be the way our ancestors consistently followed—dying of illness or old age in one's own home. With children and grandchildren gathered around, the whole family makes ready for the patient's final moment; those with faith carry out a series of end-of-life rituals according to their own beliefs. This can not only accompany and comfort the dying loved one, but also accompany and comfort the grieving family members.

I remember that when I was a child, before several relatives of my grandfather's generation passed away, all the important relatives at home would set aside their work and keep watch day and night by the elderly person's bedside.

The old people of the village would come to keep a watchful eye and help judge how long the elderly had left; the women prepared mourning cloth and mourning clothes; the children, following their elders, would also 'keep vigil' for the elder; the coffin and burial clothes had long been prepared. Most of the children could not really keep vigil through the night, so the home of the dying elderly person often had many simple beds for those keeping vigil to sleep on, taking turns on the floor.

This way of facing death together is the local tradition—just as the functional-structural anthropologist Malinowski said, traditional customs are also indispensable functional elements for a society to operate normally. With the help of such tradition, the heart of the dying person becomes much calmer; few dying people suffer greatly because they are about to die.

They may be reluctant to part in their hearts, but they also know that death is unavoidable and imminent; another conviction within them sustains them in facing death directly. Most people believe that death is not the final destination; they believe they can still be reborn and one day meet the people they love most again.

I believe such a death is far better than struggling frantically in the hospital with infinite fear of death. Especially for end-stage cancer patients, this kind of death is both humane and economical. It is also an opportunity to unite the other members of the family, and at the same time it has the meaning of death education for the family.

Generally speaking, before death a person shows some special signs; this is even more obvious in advanced cancer patients, who have long been tormented by illness and whose organs have already failed.

Once these signs appear, my advice is that the patient's family abandon all efforts and turn all their love for the patient toward preparing the final arrangements.

The most common sign is the patient's breathing changing from abdominal to thoracic breathing. The patient's breaths grow longer and longer, because the organs within the body have all failed; in this situation natural death is less than twenty-four hours away. Any rescue effort is of little significance; most medical people, when their own relatives reach such a moment, know to give up. For even if rescue measures keep the patient alive, the remaining days will be spent in bitter struggle.

Another sign is that the limbs and ears begin to show a 'waxing' phenomenon. The limbs and ears—places rich in nerve endings—of most dying people turn a waxen yellow, like a wax figure, before death; because the patient's blood circulation is very poor at this time, the limbs and ears show this waxiness first. Then patches of ecchymosis appear on the body surface; when ecchymosis appears on the patient's body, usually only an hour or two of life remains.

Swelling of the limbs and face also often means the patient is close to death; if the patient is already emaciated and, despite repeated use of diuretics in both Chinese and Western medicine and infusions of albumin, still shows swelling of the limbs and face, it generally means that fluid accumulation within the body is already very serious and natural death is near. Patients at this stage can easily die suddenly.

Sudden clouding of consciousness and inability to recognize familiar people, or phenomena such as the patient's hands clawing wildly in the air, are often signs of hepatic encephalopathy—what we commonly call hepatic coma; such patients usually pass away within seventy-two hours.

Patients with ascites mostly leave this world finally because of extreme abdominal distension; when the abdominal veins stand out prominently, treatment is of little significance. The routine methods of handling ascites work in the short term but bring no fundamental change.

End-stage patients who suddenly bleed from the mouth and nose have also mostly reached the final moment. Most patients with digestive tract cancer, especially those with esophageal and cardiac cancer, in the end are mostly unable to eat and die of severe malnutrition.

When cancer patients reach the end stage, the family should be fully prepared psychologically. After all, end-stage cancer patients who create miracles are extremely few; the great majority must face the reality of death directly.

I believe that at the final moment, what matters is not prolonging the patient's life but reducing the patient's suffering. If the patient passes away after torment, the family easily falls into depression afterward and cannot emerge from grief and self-reproach for many years. The family must be rational, and doctors should also help the family build up a psychological defense system for coping with death.

After the patient passes away, the bereaved family needs the support of relatives and friends during the mourning period. Some fine mourning traditions in our country are being lost, such as in the past inviting Taoist priests to perform the 'seven-day rites' (zuo-qi) for the deceased. When I was a child, from the first seven days to the seventh seven days after a person's death, every seven days a Taoist priest would be invited to the deceased's home to preside over a memorial ceremony, and important relatives would attend. On the first day of the lunar New Year of the following year, everyone in the village would go to the deceased's home to pay respects; on the second day of the New Year, all the relatives of the deceased would go to the home to pay respects.

These are not merely superstitious activities; they are also a very wise means, invented by the ancients, to help the closest relatives of the deceased gradually free themselves from the enormous pain brought by the death.

These customs of the 'seven-day rites' and memorial visits can rally the strength of the deceased's family and help those closest to them soften their pain. Of course, through this devotional means they can also express their grief. Such measures can greatly ease the sadness and depression of the deceased's closest kin.

In modern society, after everyone dispensed with this procedure, the immediate relatives of the deceased lost necessary social support and also lost a way to express grief, so that many people, after their closest kin died, fell into deep depression.

The island effect of modern human relationships is especially evident at such moments; the only-child generation produced after China's family-planning policy is even more at a loss when encountering such a situation.

The first few dozen days of mourning should be accompanied by important relatives and friends. For the great majority of ordinary people, having a religious belief may be better than having none, because at least when facing death, religious belief can provide spiritual comfort to some people.