Practicality in dying?

Madam Foong’s* case is one such example of a family going through distress. Madam Foong was in the terminal stage after having gone through multiple lines of chemotherapy for breast cancer. At each clinic visit she complained about pain. When she finally admitted to not taking her pain medication regularly, she was advised to comply. At her next visit her pain was somewhat under control but she appeared unduly agitated. I decided to explore the topic on dying and observed her quick interest. I explained that many people failed to realize that in the case of sudden death, there was no opportunity to say goodbye. Her husband and daughter were with her and I suggested that perhaps she could plan what she wished for her funeral. She seemed to accept that idea.

Her husband visited me on his own, saying he felt helpless. Nothing he did seemed to please her. I explained to him that being her husband, she was most at ease with him. Hence, she vented her annoyance at him regarding the failure of her treatment. However, as she had now accepted her terminal state, she had been willing to listen to advice about preparing for her own funeral. I advised him to support her in her decisions and be there for her.

Her daughter likewise came to see me with a dilemma. Her mother was from a different religious order where the funeral costs are high. The family tried to persuade Madam Foong to convert to a different religious order for the sake of a cheaper funeral. She finally agreed with her husband's support. During the next clinic visit, I observed that she was smiling and more at peace.

According to the family, the final two months at home, she spent her time on funeral preparations as the way she wanted it and bid goodbye to all her loved ones. She did not complain much about pain after that and died peacefully. Her family was grateful that the subject of dying had been initiated with her during the clinic visit as they were uncomfortable with that topic.

This case highlights few pertinent issues that we doctors find hard to discuss. One is the question of dying and the other on practical issues dealing with funeral expenses.

Madam Foong was aware of the family’s financial situation and of the high cost of funerals. This bothered her so much that it caused mental anguish that she described as “Pain”. But it was an emotional pain she was experiencing, that of not wanting to financially burden the family. In Asian families, discussion of death is almost taboo and apt to be misunderstood both by the dying and the relatives. My intervention as a neutral party, though done with great trepidation, literally gave them permission to now discuss this taboo subject and make a controversial decision. This may have liberated her from her pain. Hence, instead of focusing on why the treatment did not work and worrying about financial problems, she was busy doing something meaningful for herself and spending quality time with her family.

Religious conversion at end of life for merely practical reasons may be frowned upon as meaningless and unethical and I am not propagating it. Nevertheless, it brought Madam Foong relief and peace of mind. Each case has to be taken on its own merit.

*The names in all these stories have been changed and in no way reflect the actual patients.