What Remains

Director He had warned me that Director Shi would be difficult to catch. "She's at a conference this morning," she said. "Come back around four." So I spent the afternoon wandering through the hospital again. Visitors came and went with bags of fruit and plastic folders stuffed with medical reports. Nurses changed shifts. The corridors seemed to breathe in slow, repetitive rhythms, as though the building itself had settled into another ordinary afternoon.

At four o'clock, someone led me to the palliative care ward. It was a completely different space compared to the rest of the hospital. The department resembled a kindergarten rather than a ward. Illustrations in childly bright colors. Group photos of cosers and minions. Calendars drawn by hands in cartoonish style. Handcrafts. Stickers. Little laughs from the nurse station. Nothing conveyed a heavy mood. Everything glowed in warm, yellowish light, in contrast with the fact that the people here were all awaiting the last moment. No one looked fearful or worried. The only expression I read was peacefulness. 

The Director looked younger than I had imagined. She wore light makeup and spoke with effortless confidence. Although patients and nurses interrupted our conversation from time to time, she never appeared hurried. Each answer unfolded with unusual precision, as though she had spent years searching for exactly the right words. But she did not mind sharing more stories at all. She welcomed other people to join the conversation. During our conversation, other people came to their physicians just to chat, starting new conversations alongside ours. Sitting in the same office with all other physicians, she appeared no different to them. The Director was sharp and easygoing at the same time.

I had prepared questions about palliative care. She answered with a wedding photograph. There was once a young couple who had married with almost nothing, not even a wedding ceremony. Before becoming ill, the wife had always wanted to wear traditional Chinese bridal clothing for a proper set of photographs. Cancer arrived before that dream ever did. She was already too weak to leave the hospital. "So," Director Shi said simply, "we brought the studio here." The department contacted a photography studio willing to donate the costumes and equipment. Makeup artists came to the ward. The hospital room became a temporary dressing room. Nurses helped prepare everything.

But that was only the beginning. The team also contacted an embroidery artist who specialised in preserving hair within embroidered artwork. "We often say," Director Shi told me, "that true death isn't when life ends. It's when someone is forgotten." After the photographs were taken, several strands of the patient's hair were carefully preserved and stitched into the finished portrait. What her husband would keep would no longer be only a photograph. A part of her would remain inside it.

The story did not end with the patient. It transformed the family as well. The young woman's parents, both disabled, lived far away and had been unable to care for her during treatment. She had largely been raised by two aunts, who had travelled to accompany her instead. At first, they distrusted the ward completely. To them, palliative care meant surrender. A young woman belonged back in her hometown, not in a place associated with dying. But preparing the photographs required weeks, so long that it was enough for doctors to convince them. Gradually, suspicion softened into familiarity. When the photographs were finally taken, the aunts stood beside her. The team even arranged portrait sessions for them in elegant qipaos. "The atmosphere in the family changed," Director Shi said. The photographs had not cured anyone, yet somehow the family had healed themselves.

Until then, I had unconsciously imagined palliative care as medicine's final chapter. Director Shi gently corrected that assumption. "The biggest misunderstanding," she explained, "is that people think we're simply waiting for patients to die. Palliative care is not the stop before the morgue." She shook her head, "If someone only has a few hours left, there's actually very little palliative care can do." Those words surprised me. She explained that meaningful care required time. Time to control pain. Time to mend broken relationships. Time to celebrate birthdays. Time to discover the wish that had never been fulfilled. If a patient arrived unconscious and died several hours later, none of that could happen. All that remained were emergency paperwork and grief for both the family and the medical team. "Our work isn't simply accompanying death," she said, "It's helping people continue living with quality until death arrives." 

That philosophy shaped everything in the department. Patients were admitted only when three conditions were met: their condition had to leave at least a week for meaningful care; families needed to understand that the illness could no longer be cured; and most importantly, everyone had to accept what palliative care was trying to achieve. It was not prolonging life at any cost. It was simply relieving suffering while respecting the natural course of life.

She admitted these rules sometimes led to complaints. Families occasionally believed any available bed should accept their loved one. But experience had taught the team painful lessons. Without time, there could be no conversations. Without conversations, there could be no trust. Without trust, palliative care became indistinguishable from an ordinary hospital ward but with additional rushing about and exhaustion. “We’ve had such cases,” she sighed quietly,” The family did not send the patient to the hospital until the patient was dying. The patient passed away in a few hours after admission. The family ended up making a complaint to our department. It was like killing the goose that lays the golden egg in the long term.” For physicians, conservative policies seem to be the only shield from that. 

We began speaking about death itself. In many Chinese families, she explained, the diagnosis remained hidden from patients until the very end. But the moral burden of telling the truth only becomes heavier. While families wanted to protect hope, doctors wanted to respect autonomy. Reality rarely fits neatly into either principle. "Every family is different," she said, "If someone only has a few days left, suddenly forcing the truth upon them may not actually help." Medicine, ethics and love did not always point toward the same answer. Instead of following rigid formulas, her team tried to understand each family before deciding how to proceed. Listening, once again, became part of treatment.

Toward the end of our conversation, the discussion widened beyond the ward.

She spoke frankly about medicine itself.

Doctors, she said, now worked under immense pressure.

Public expectations continued to rise.

Resources remained limited.

Complaints could arise even when doctors had done nothing wrong.

Many people regarded healthcare as a customer service industry.

"If the illness isn't cured," she said, "some people think someone must be responsible."

Yet biology did not obey customer satisfaction.

Disease progressed despite everyone's best efforts.

Sometimes medicine simply reached its limits.

That, she believed, was one of the hardest truths for society to accept.

Our interview stretched longer than either of us had planned.

Outside, evening had begun settling over the hospital.

Visitors were changing again.

Dinner carts rattled through the corridors.

Somewhere beyond the windows, the city continued with its ordinary routines, almost unaware that, inside this building, people were quietly negotiating with mortality every day.

Before I left, Director Shi wished me luck with medical school.

I thanked her for giving up part of her afternoon.

Walking back through the corridor, I found myself thinking less about death than about memory.

I had arrived expecting palliative care to be about endings.

Instead, I left believing it was about what remains.

A photograph.

A few strands of hair.

A conversation finally spoken.

A family that learns, little by little, how to keep loving after letting go.