The Last Hours-1

The respiratory care department was quiet at midnight. Because the quarantine had just been lifted, few people were in the hospital. The only sound was the rhythmic, mechanical breathing made by the respirator. 

When my aunt began telling me about her mother, she did not begin with the hospice ward. She began with a hospital corridor. Her mother had been diagnosed with advanced lung cancer during the COVID-19 pandemic. 

After ten days of permitted stay, she was forced to make a decision about where her mother should spend her remaining days. The usual routes seemed to have narrowed into only two: intensive care or home. Neither felt right. The family had already learned that her condition could no longer be reversed. What they did not know was what to do with the time that remained. The hospital had told them that her mother could no longer stay in an ordinary ward. She was too ill, and her condition required a level of care that a general ward could not provide. The next option was the ICU.

At first, my aunt almost agreed. It was not because she believed the ICU could cure her mother. It was because, when a doctor tells you that someone you love is critically ill and needs intensive care, refusing can feel almost like refusing to save them. The ICU was also available. That fact mattered more than she wanted it to.

The ICU director repeatedly came to speak with her, encouraging the family to transfer her mother upstairs. The cost was enormous—roughly five or six thousand yuan (741-889 dollars) a day for the ICU bed itself, before other treatment and care costs were added. The total could approach ten thousand yuan a day.

But the money was not the only problem. My aunt asked the question that mattered most to her: could her family stay with her mother? The answer was no. Because it was during the pandemic, relatives would only be allowed to enter the ICU during a limited visiting period. Her mother would spend most of her remaining time separated from the people who loved her. 

That possibility disturbed my aunt deeply. Her mother had already spent the last stage of her illness surrounded by restrictions and uncertainty. Family members could not always travel freely. Some relatives lived in other cities. There had already been periods when they simply could not see her. Now, at the moment when they might have the least time left together, they were being asked to choose a place where they would barely be able to see her.

My aunt could not accept it, "If she can't be cured anymore, why should we send her to the ICU just to prolong it?" She did not mean that she wanted to give up on her mother. Quite the opposite. She wanted to be with her. Her family's principle was simple: if medication could relieve her mother's suffering, then they would continue using it for as long as it helped. But they did not want to pursue aggressive interventions merely to prolong the dying process.

The alternative was to take her mother home. That sounded more humane at first. But when my aunt thought about it practically, she realized how impossible it would be. Her mother was already having difficulty eating. She required medication and medical care that the family did not know how to provide. They were family members, not trained healthcare workers. They could love her, feed her, sit beside her, and hold her hand—but they did not know how to manage a critically ill patient at home.

There was a third option: the observing room. It was small and cold, designed for unstable patients that needed further observation. In reality, it housed the patients that could not be accomodated in any department. My aunt rejected it almost immediately. So they were trapped between two choices. The ICU could provide medical care, but the family could not stay. Home could provide family, but the family did not know how to provide the care. And somewhere in between, my aunt kept asking the same question: Was there another way?

After refusing the ICU option, the director left in frustration. It was then that a young doctor in the hospital mentioned something she had barely heard of before. A hospice ward. At first, she did not even understand what the doctor meant. "What is hospice care?" The doctor explained that there was a ward where patients who could no longer receive curative treatment could spend the final stage of their lives with their families. Instead of focusing on aggressive treatment, the ward would focus on comfort. Instead of separating the patient from the family, it would allow relatives to stay together. My aunt immediately became interested.

She had heard that there were two hospitals in Liuzhou offering this kind of care. One was the Rongjun Rehabilitation Hospital; another was a traditional Chinese and Western medicine hospital. The first one was especially convenient. It was near her neighborhood. She could walk there in a little over ten minutes. That small fact suddenly made the unfamiliar idea feel much more real. "If it's that close," she thought, "then why don't we transfer her there?"

The original hospital cooperated with the transfer. An ambulance took her mother to the hospice ward. But arriving there did not mean the family had simply found another hospital room. Before admission, they had to sign a series of agreements. The most important condition was also the most difficult to accept: once admitted to the hospice ward, the patient would not be transferred elsewhere. My aunt remembered the weight of that decision. They were not simply signing admission paperwork. They were acknowledging what this transfer meant. This was where her mother's final journey would take place.

Before signing, my aunt asked the doctor how much time her mother might have. The answer was surprisingly specific. About one week. That estimate gave the family something they had not had before: a rough shape for the future. There were no longer months to imagine, or years to hope for. There were only a couple of hours left.

The hospice ward itself was unlike anything my aunt had expected. She had imagined a hospital, but what she found looked more like a home. The room was private. There was a bed, but the bed did not dominate the space. There was a large television, a refrigerator, a microwave, a washing machine, a dining table, and a sofa where a family member could sleep. There was even a place to shower. The room had warm colors instead of the institutional white she associated with hospitals. There were plants and a balcony. The furniture was ordinary household furniture rather than rows of clinical equipment. My aunt remembered one detail particularly vividly: the sofa was orange. "It didn't feel like a hospital," she told me. "If you didn't see the bed and the monitoring equipment, you wouldn't even know."

The difference was not merely cosmetic. The entire logic of the ward seemed different. In a conventional hospital, she was accustomed to seeing doctors at the center of everything. Doctors examined patients, made decisions, ordered treatments, and moved quickly from one patient to another. Here, the nursing team seemed to occupy a much more visible role. The head nurse coordinated the care. Nurses were constantly monitoring the patients. A call button was within reach. If something went wrong, doctors could come over quickly. The family did not have to figure everything out themselves. That mattered enormously. 

Her mother needed professional care, but the family also wanted to remain a family. They hired a caregiver to help with things they did not know how to handle. During the day, relatives stayed with her mother. At night, the caregiver remained with her while the family went home to sleep. Because the hospital was so close, they could walk back and forth. My aunt described their routine almost like a household schedule. They would arrive early in the morning. Stay with her mother throughout the day. Talk with her. Watch television. Eat together. Ask her questions. Then, around eleven at night, they would leave the caregiver with her and walk home. The next morning, they would come back. 

The more my aunt talked about the room, the more she returned to the same idea. The hospice ward was not simply treating a patient. It was also caring for the people around that patient. She remembered how different the atmosphere was from the large hospital they had just left. In a major hospital, she understood why doctors and nurses seemed rushed. There were too many patients, too many emergencies, too many things that needed to happen immediately. The whole environment was built around urgency. In hospice, that urgency disappeared. The doctors were no longer trying to reverse an incurable disease. The nurses were no longer racing against time to perform another intervention. The family was no longer asking: "Where can we find another treatment?" Instead, everyone seemed to understand the same thing. There was not much time left. And that was precisely why the time mattered.

My aunt told me that this changed the way everyone behaved. The medical staff spoke more calmly. They explained what was happening, reassured the family, and taught them what they could do. If her mother became uncomfortable, someone would come. If medication was needed, someone would come. If the family did not know what to do, someone would tell them. Even after death, there was a process. The staff would help contact the funeral service and explain what needed to happen next. The family did not suddenly find themselves standing in an empty hospital corridor, wondering who to call. That sense of continuity was something my aunt had never experienced in a hospital before. She described it simply: every time they reached the next step, they knew whom to ask.

Yet her decision had not been easy. In fact, she told me that she almost chose the ICU several times. The pressure was enormous. The doctors in the emergency department were repeatedly asking her to decide. Her mother was critically ill. They needed an answer. But my aunt refused to make the decision alone. Her mother had another daughter, and she insisted that both daughters needed to see the situation and decide together.

She did not want to wake up the next morning and wonder whether she had made the wrong decision. More importantly, she wanted to give herself time to think. She stayed through the night. The doctors continued suggesting options. She continued asking questions. She looked at the observation area. She considered going home. She considered whether they should transfer her mother somewhere else temporarily. None of the choices seemed right. And she still had not heard anyone clearly explain hospice care. Then, sometime late at night, when the emergency department had become quieter, another young doctor approached her. He had been listening to the conversation. He understood what she was trying to say. The doctor told her there was another option. 

My aunt suddenly remembered something. Two years earlier, a high-school classmate had mentioned that he worked at the very same hospital. He had once joked that when they were old, they should all remember to find him because the hospital had opened a hospice unit. 

At the time, the comment had seemed distant and almost irrelevant. Now she suddenly remembered it.

She called him. He happened to be away on a business trip, but he confirmed that the hospice ward could receive her mother. And, importantly, he told her that they did not need special treatment or personal connections. They could simply follow the normal admission process. The costs were transparent. There was a bed available. The hospital could arrange the transfer. For the first time that night, my aunt felt that she had found an actual alternative. Not a miracle. Just another way of spending the time that remained.

There was still one thing she worried about. The price. She had already heard the ICU figures. Five or six thousand yuan a day could not make things any better. So when the young doctor mentioned hospice care, she immediately asked: "How much?" The doctor called the hospice ward in front of her. There was a room available. The room cost about one hundred yuan (15 dollars) a day at the time. The caregiver was an additional expense, but the room and ordinary medical expenses were much more manageable, with many costs covered through insurance.

My aunt was almost surprised. The room looked so different from an ordinary hospital room that relatives initially assumed it must be extremely expensive. But it wasn't. The family could afford it. And unlike the ICU, they would be able to stay with her. That was what finally made the decision possible. They transferred her mother. And, as soon as they entered the hospice ward, my aunt knew that they had made the right choice. She had spent hours being asked to decide between treatment and abandonment. But hospice care gave her a third possibility. It allowed her family to say: we know she cannot be cured, but we are not going to leave her alone; we are going to make those days belong to her.

That was why hospice mattered so much.