The old Chinese man was admitted with uncontrolled pain and breathing distress. His wife and son doted upon him and were worried about him as he had been rapidly worsening over the past weeks. He had previously had fluid from around his lung drained in hospital the other month, which had helped his breathing. His symptoms were controlled quickly but he still felt exhausted.

Even speaking to him in his native Mandarin Chinese it was difficult to tell what he really wanted. He appeared to know that things were worsening. It was just before New Zealand’s general election, and the End of Life Choice Act 2019 was being considered for enactment via National Referendum. He told me that he had already cast his vote and was in support of having the option of assisted dying. His son quickly told him that even if it was voted in that it could not be accessed until another 12 months.

At other times he asked if there were any other treatments available to keep him alive longer. I explained what his other specialists had told us, that there were no active treatments available and that only symptomatic cares remained. Over the next week he slowly deteriorated, becoming more and more breathless and tired each day.

He asked if he could go back to hospital to have fluid drained off from around his lungs. I didn’t think it would help him much, and might actually lead to more discomfort. This was of particular concern because I thought that his time had become short.

In terms of prognostication a general rule of thumb we use depends on the rate of deterioration. If things are changing over months, that usually means that there are only months left to live. If changes occur over weeks, then there are weeks left, days mean only days. I was concerned that he possibly only had days to weeks left to live.

He and his family were keen to try the chest drain again, as he had benefited from it the last time he had it. I tried to talk him out of going back to hospital, but they were all keen on trying at least one more time. He went off to hospital for the procedure and we held his bed.

He returned a week later, much worse for wear. He had his chest drained and had other painful procedures, but it didn’t really help him. He had a stressful time in hospital, with worsening pain and general discomfort. The whole family were glad to return to hospice, and we made him comfortable quickly.

He died three short days later and his son and wife were devastated to lose him. They did not regret his hospital admission as they had wanted him to try his best to keep on going.

Lesson learnt:

People may be able to come to terms with their situations in their heads, but the emotional heart usually takes longer to let go. Even at the end of his life he wanted to try one last time to stay with his family longer.