Dying and Grieving 'To die a good death is to have lived a great life ... come celebrate my life at my funeral services on Sunday.' It is unusual that anyone would want to have anything to do with their own funeral notices, but 39-year old blogger Foo Hee Boon did. Diagnosed with metastasised non-small cell lung cancer in March last year, Foo documented the final lap of his painful journey, as a cancer patient facing death, in his blog Hee Boon's Amazing New Adventures. He died in August this year but his blog lives on ( http://fhbadventure . blogspot.com/), providing insight and hope for others around the world. One of the greatest fears a human being has is the unaccompanied journey that we all must make to that unknown place called death. In the Chinese culture, death is a taboo topic. 'People think that talking about death is negative, giving up and discouraging,' Cecilia Kwan, chairwoman of the Hong Kong Hospice Nurses Association, said. Cecilia Chan Lai-wan, director of the University of Hong Kong's Centre of Behavioural Health, said: 'People don't talk about it; they don't think about it; they don't do anything to prepare for death.' As a result, she said, death usually came along too suddenly and this led to unnecessary regrets. 'It is important for dying patients and their family members to learn to die well and to grieve well and effectively,' she said. Professor Chan is also an executive committee member of the Society for the Promotion of Hospice Care and vice-chairman of the Society for Life and Death Education. Elisabeth Kubler-Ross, a psychiatrist and world-renowned author of several books on death and dying, reminds us of the importance of making friends with death. 'Those who learned to know death, rather than to fear and fight it, become our teachers about life,' she wrote in her book On Death and Dying. When death stares a cancer patient in the face, it is an extremely stressful time, not just for the patient but for all family members concerned. Anxiety, fear, apprehension, guilt, pain and a myriad of other feelings collide in a mass of confusion for everyone involved. Professor Chan said the patient might begin to experience regret. He would become distressed by the things that he wanted to do but was unable to achieve with his limited time. This unfinished business weighs heavy on his mind. He may worry about the family members he leaves behind and starts to feel sorry and guilty for not being able to fulfil his obligations to them. This is especially so if the patient is the breadwinner for the family and owing to his illness is unable to make further provisions for them. Grace Chow, author of the book A Pain in the Neck and a short blog documenting her last two months of life called Dying Is ... ( http://dyingis.blogspot.com/ ), expressed this uncertainty in a poignant manner. 'I thought I was going to grow old with Ton [her husband]. Now I'm supposed to leave him on his own. Who would be there at home to help if he were to suffer a bout of hypoglycaemia due to his diabetic condition? Who's going to support him when he's down?' Chow died in 2004 at age 32 from a very rare tumour at the base of her skull called chordoma. Professor Chan said anxiety would also arise from the spiritual issue of what happened after death. This fear of the unknown frightens the patient. And on top of all these heavy emotions is his deteriorating health and having to endure physical symptoms such as breathing difficulties and excruciating pain. There could also be loss of mobility which means the patient will need to rely on others to perform basic life activities like eating and going to the toilet. This dependence on others and the accompanying loss of human dignity is a painful cross to bear for many people. Foo's blog states: 'My mom is bathing me again because physical exertion renders me breathless. So sorry for my mom to bath her ailing son. I apologise to my mom because instead of me taking care of her in her twilight years, I am the one that needs taking care of.' Where family members are concerned, one of the greatest fears on their part is having to let go of the patient. Professor Chan said they often refused to accept the fact that their loved one was dying, and this might prolong the suffering of the patient. 'In situations where the illness is terminal and severe, it is better to give permission for the loved one to die.' Family members may also worry about their future, financially and emotionally. Death brings with it a change in life meaning and life goals for those left behind and this demands adjustments on their parts. A heavy sense of guilt or self-blame was a form of emotional distress that was common among family members of the patient, Professor Chan said. They might blame themselves for the situation that the patient was in, and suffer through different scenarios of the 'If I had done this or taken him to this doctor, his illness might be prevented' variety. Professor Chan emphasised the importance of dealing with death and preparing for it. 'Preparing for death is to consolidate the meaning for life. It is a very important life process,' she said. 'It can be a life transforming thing and a positive opportunity for an open declaration of love for each other. A cancer patient I worked with said that by having cancer she realised how much her family members loved her.' A family meeting would be a good place to start resolving some of these issues. It was a good idea to plan with the dying patient what would happen after his death, Professor Chan said. 'To be assured that surviving family members can carry on and live happily will relieve the worry which is a great burden on the dying patient,' she said. A major source of emotional distress and regret is all the unfinished business that the dying patient leaves behind. Talking about them and taking on promises for the dying patient removes the worry on both sides. 'So we have to talk about these things with humour and energy,' Professor Chan said. She remembered a mother in her 30s, stricken with cancer when both her children were still young and worried about how her husband was going to handle two small kids when she was no longer around. The family talked about how they would raise the children including all the practical arrangements necessary for their upbringing. They concluded that they were very proud of the kids and expressed how important they had been to each other. They even shared plans that included having the children visit the mother's grave site and the children's graduation. The discussions resolved a lot of uncertainty and when the wife died, the family coped effectively. For those left behind, life has to carry on. Chow's husband, Ton, penned the final entry in her blog: 'Still letting go was difficult, she loved me and the world too much. She pitied those who loved her madly, because now we have to live on and deal with the loss while she found her peace. She will never return and still she will never leave.'