When Treatment Becomes a Superstition, Death Becomes a Painful Process

Not long ago, the family of a terminal ovarian cancer patient, recommended by her classmate—another physician—came to me, asking me to help her mother relieve suffering. This patient developed intestinal obstruction with every chemotherapy cycle; her condition was already very serious, and the possibility of cure by chemotherapy was very low. I helped her relieve some clinical symptoms and eased her suffering, with a slight effect.

But the family was not reconciled; in addition, two of the patient’s nephews were doctors working at Grade-A tertiary hospitals, and these two relatives uniformly insisted that the patient rely mainly on Western chemotherapy. I advocated giving up chemotherapy under this real predicament, but when my opinion clashed with those of the patient’s closest relatives, it was not heeded. After the patient’s children discussed it, they decided to give her one more chemotherapy; I could hardly say anything more.

This chemotherapy directly caused severe intestinal obstruction, with side effects greater than all previous chemotherapies: she could not eat or defecate, was in pain, and her blood counts dropped sharply; every day she could only be kept alive by intravenous nutrient infusion, and her condition worsened day by day. Recently the attending doctor talked with the family, saying that the patient had reached her final days and they should prepare for the end. The patient wished to return to her roots and go back to her hometown. The attending doctor worried she might not even make it home; fortunately, she did.

After returning home and stopping the infusion, the patient’s condition actually improved considerably compared with in the hospital. Even so, with the condition so severe, her remaining days were numbered. The family still could not give up, and hoped I would continue treating her to see whether a miracle might occur. I felt that treatment would now mean little, so I only suggested they use some simple external methods to relieve the patient’s suffering.

I have encountered this kind of situation many times before. About ten years ago, a nurse’s mother was also in late-stage cancer, receiving intravenous drips every day, and her condition deteriorated day by day; the attending doctor also told the family to prepare for the end. Later she decided to bring the old mother home; two days after stopping the infusion, the old woman’s condition markedly improved. She asked me why this was so. I told her that the patient’s body was already weak beyond endurance, and the infusion was burdening every organ, so the more she was treated, the worse she became; stopping the infusion was actually better, and no surprise.

I prescribed some orally taken, symptomatic Chinese medicines for this patient, telling her to take some when she felt like it and not force it when she did not. If the medicine improved things, continue; if not, stop it. After taking the medicine the patient’s condition improved somewhat, and slowly she was even able to go downstairs and move about. Her daughter later thought that, since the old woman had recovered, she could undergo some more treatment, and brought her back to the hospital for infusion. After the infusion resumed, the old woman’s body rapidly collapsed, and she passed away soon after.

Last month, the daughter of a patient in Inner Mongolia came to consult me about how to treat her father’s liver cancer. The daughter had known me for more than five years; her mother had cervical cancer, and five or six years ago she had brought her mother to me for treatment. Unfortunately, her father this year developed liver cancer; before the liver cancer, her father had already been paralyzed by other diseases, with most of his body numb and requiring around-the-clock family care. After this liver cancer diagnosis, relatives still urged her to give her father proper treatment.

The local hospital proposed chemotherapy; I do not think such treatment means much for this patient. Moreover, their family’s finances were very poor: with three seriously ill patients, they simply could not afford continued treatment for her father. During hospitalization, the patient was often in a state of persistent high fever. I therefore suggested she bring her father home for home care and treatment. Do not use too many drugs; if the fever continues, simply use Xiao Chaihu Granules to bring down the fever.

This family followed my advice, brought the patient home, and used Xiao Chaihu Granules to reduce the fever; the patient’s temperature came down and never again exceeded 37 °C. Her appetite returned, she could take liquids, and it has now been more than a month; her condition is actually better than during hospitalization. The family also settled down and stopped rushing about.

In the final days of my own mother’s life, I made medical decisions in the same way. I only aimed to improve her quality of life, not to prolong her survival. So two days before my mother died she could still go out and play cards; later she had a second stroke and lost consciousness, and my relatives urged me to find some way to rescue her. I gave up. The moment of departure must come eventually; rather than let stroke sequelae and terminal cancer together torment my mother, it was better to let her go more lightly.

Did my heart ache when my mother died? It ached terribly. But now my mother has been gone ten years, and in these ten years I have watched many cancer patients die after long torment. Looking back, I am glad that, driven by no foolish filial piety, I did not superstitiously believe in treatment and let the old woman suffer.

Too many people have an irrational superstition about medicine, insisting on treating to the very end, as if not treating to the end were being irresponsible to one’s loved one. Excess is as bad as deficiency; such treatment instead accelerates the patient’s death and lowers the quality of life. When I talk with families of terminal patients and tell them that further treatment means little, some families often challenge me: "Are we just supposed to wait for death?" Medicine is not omnipotent; an illness too severe cannot be cured, and even if one does not want to wait for death, it is impossible.

When medicine is powerless, giving up treatment is not the worst choice; worse than that is treating recklessly. For treatment does not, as people hope, always improve the patient’s condition. When the patient can no longer improve and may even suffer serious side effects, continuing treatment only hastens the patient’s departure, and the process of leaving is more painful than a natural death.

A mature-minded person should have enough reason to face death. Not long ago, an ovarian cancer patient in her eighties developed ascites, and her family came to me for hospice care. I relieved her suffering as much as I could; after treatment her strength improved, her appetite improved, and for a time she could even do light work. Although in the end the patient inevitably died, the family was already quite satisfied with this improvement-oriented treatment, and it did not cost much. The family was grateful, and after the patient died, they politely thanked me. I believe this is ideal hospice care and an ideal doctor-patient relationship.

Whether doctor, patient or patient’s family, only by not superstitiously believing in the value of treatment can one avoid overtreatment. Giving up the goals of cure and life extension and adopting hospice care is a rational choice and also the best care for a loved one who is about to leave us.