Sun is dying.
There are tubes running into his neck. Oxygen tubes come out of his nose. It is upsetting to follow him on Facebook, as his physical spiral downwards is fast and furious and plain to see -- with the exception of one important person in this drama.
Sun has tuberculosis. His lungs, according to his brother, are failing and he needs to be on a respirator. He spends most of his time in a hospital bed, separate from other patients, watching daytime TV.
Now and again his doctor allows him to go home. He lasts about 12 hours. By nightfall he is having difficulty breathing, so he packs his bags and returns to hospital.
His Facebook posts over the last six months read like a journey towards death, as his face grows more and more gaunt. His face looks older than his 32 years, and he is as skinny as a rake. You know that round pic at the top of your Facebook page? Sun's is a photograph of him from two years ago showing how handsome he was with his short moustache and high cheekbones. It is now juxtaposed against the bigger, rectangular photograph, taken not a month ago from his hospital bed, looking up to the camera with giant eyes, his hair sweaty and straggly, his red-blotched skin wrapped taut around those cheekbones.
In that photograph he has a single index figure up against his lips, as if he has a secret he doesn't want anyone to know. What could that secret be?
Who knows? But there is one big secret being kept from Sun himself.
Sun is dying … but nobody has told him.
"It would upset him too much," says his brother.
Sun is the latest in a line of Thais I have known throughout the years who have been stricken with an incurable disease without being informed.
The one before him was my friend Veerasak's father -- a hard-working rubber plantation owner who, despite never having smoked a cigarette in his life, was diagnosed with lung cancer in his late 60s.
His dad's descent was relatively quick. Within six months he was in hospital gasping for breath. It was tragic watching this once-robust, kind man waste away to almost nothing.
"How does your father feel about dying?" I asked Veerasak one night in the hospital smoking area -- such is the stranglehold of addiction, Veerasak's father's fate wasn't enough for his son to quit.
"He doesn't know," said Veerasak. "We haven't told him."
Back then I performed a non-scientific survey about this curious situation (ie, asking Thai friends and colleagues), and it does appear to be a thing here in Thailand. When a family member such as a parent falls terminally ill, they are often not informed. By doing so, it will only upset the patient, which will make them lose hope, which could hasten the process.
This is a line of thought that is understandable, though I cannot subscribe to it.
First of all, there is a fundamental logic problem attached to it. A terminal patient, such as a stage four cancer sufferer, has only one final outcome. By not telling the patient of that outcome, you give the patient hope.
And yet there is no hope. The patient is going to die. What is the point of giving a hopeless patient hope?
I have a close friend in Australia who is a doctor working in palliative care. I have a relative who is a paediatrician. They both say the same thing: the single, solitary good thing about being diagnosed with a life-ending disease in advance is that you are able to make plans.
"If I have six months to live, then I can at least put my house in order before I leave," my friend said. "The worst cases are those patients who die suddenly. Their finances are a mess, they don't get to say goodbye to their loved ones, and their families are more often than not left with untold loose ends."
My doctor relative agrees. But what of the shock of knowing? She points me to Elisabeth Kubler-Ross, the late psychiatrist, who in her book On Death And Dying laid out the five stages of grief upon knowing you are dying -- denial, anger, bargaining, depression and acceptance.
Those first four stages must be hell to go through. But they lead to the final stage, acceptance, and surely this is the state of mind we must all aspire to on our deathbeds.
I witnessed this with a dear Australian friend, a most beautiful woman who, at the age of 28, found out she had stomach cancer and was given two years to live. She went through it all. The last time I visited her she was in her acceptance phase. Her impending death was no longer the elephant in the room. It was, ironically, now a part of her life. Once after chemotherapy, for example, we went shopping for wigs. She had been in control of her departure.
This is something Veerasak's Dad never worked through, nor Sun. And by denying them the knowledge, they are denied the opportunity to make plans.
I was blunt with his brother; Sun is not stupid. Doesn't he know he's dying?
"He knows he's sick," he said. "But we haven't told him his lungs are almost all gone. He still has hope, and we don't want to deny him that." Up pops that "hope" part again. "And anyway, none of us in the family wants to be the one to deliver the bad news."
That I understand … but what about his doctor? Doesn't a doctor have an ethical duty to tell an adult patient of his impending death?
Apparently not. In the case of Sun, his doctor has never said a word about him dying. As little as three weeks ago, according to Sun's brother, the doctor even told Sun that around half of people with tuberculosis can recover. To me this is irresponsible. It is questionable enough to give a terminal patient hope, but giving them false hope?
It was the doctor of Veerasak's father who ultimately let the cat out of the bag, in the worst way possible. When the poor man was gasping for air in hospital, his doctor said: "You'll die in the next 48 hours. Do you want to die here or at home?" What a thing to ask a man clinging to an oxygen tank for life, thinking he still had a chance of recovery, because nobody had passed on important information. He died three days later at home.
My heart goes out to Sun, also gasping for life from an oxygen tank, surrounded by friends and family. He has an estranged wife and five-year-old son who live in the far North. I asked his brother if he'd called them to tell them of Sun's fate. There may be bad blood between Sun and his former partner, but if I were dying I'd surely want to see my kid for the last time.
Sun's brother hasn't called: "If his son came, he'd find out, wouldn't he? He'd put two and two together."
It's too tragic a situation for me to interfere in. Let the yawning chasm of cultural difference remain in place, and let Sun receive as little suffering as is humanly possible.
As for that single finger pressed up against his lips in that Facebook photo, perhaps Sun is conveying a simple yet reassuring message: "It's OK. I know."
