Letting go of a loved one: When roses matter more than bread

Letting go of a loved one: When roses matter more than bread

https://www.straitstimes.com/opinion/letting-go-of-a-loved-one-when-roses-matter-more-than-bread

2025-03-23

By ---Dr Tan Kok Yang is deputy chairman, medical board, and senior consultant surgeon at Khoo Teck Puat Hospital. He is also president of the Geriatric Surgery Society of Singapore

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“My mother is a fighter, she has fought all her life and she will continue to fight for me! Please do something, doctor!” A distressed daughter said this to me as her mother, Madam A, lay desperately ill in the intensive care ward. I had operated on Mdm A just two days earlier for gangrenous intestines. The patient was overwhelmed with infection. The machines were barely able to bring oxygen to her tissues and the medications that we used to support her life had made all her fingers and toes turn bluish black.

I struggled to help the daughter understand the likely futility of our medical care. The bond between this daughter and her mother was clearly very strong and it broke my heart to dash her hopes. Mdm A was a single mother and had struggled through great hardship to raise her child. The daughter had gone on to do well in life and now her dreams of giving her mother a life she never had, some recompense for the sacrifices she made, were being shredded by the spectre of death. As she cried, I noticed the barely conscious Mdm A had tears welling in her eyes too.

What is it about death that is so difficult to accept? I do not presume to know what it feels like to face death as I have not had that experience. But to have a loved one die can be a frightening experience as well.

What is so frightening about death for those left behind is the finality of it and the dissonance – of seeing how everything continues after a death and yet, for that person who died, time has stopped. With that, gone are the opportunities to do even the simplest of things with your loved one, to chat, to spend time doing nothing in particular together.

It is this sense of permanence, the irrevocable disruption of dreams and hopes that makes death so frightening and painful for those in its anteroom.

Research has revealed that the circumstances of a loved one’s death have a profound effect on the mental well-being of those grieving. One multi-centre study found that when a loved one dies in critical care, the grief is more intense and prolonged. Six months after such deaths, those left behind found it 50 per cent more difficult to move on. Grieving processes for each individual also follow very different courses and different time continuums.

In the case of Mdm A, I did what I thought was the most appropriate when dealing with her distraught daughter. I concentrated on explaining the medical facts. I explained to her what we were doing for her mother, how we were supporting her life and reassured her that we were doing the best we could. We explained to her the medical food that we were giving her mother to nourish a body battered by infection and medical treatment.

What embodies life? Energy, enthusiasm, the spirit to learn, the courage to love and, most importantly, the ability to bounce back from a fall with a smile.

One usually associates these qualities with a child, fresh to this world as we know it. Arguably these qualities of living continue into adulthood and older age. These are likely the very qualities we will appreciate in our loved ones.

But when critical illness suddenly strikes, our focus is not on the life lived by our loved ones but on what needs to be done to keep them alive.

Bread and Roses

In a plenary lecture delivered by general practitioner and writer Iona Heath at the North American Primary Care Research Group meeting in 2024, she talked about bread and roses in medicine. She explained that bread is what makes life possible while roses are what makes life worth living and both warrant attention in medical care. Bread and roses was used as a political slogan in the early 1900s, this was then turned into a poem by James Oppenheim when he was 28 years of age. He wrote:

Small art and love and beauty their trudging spirits knew.

Yes, it is Bread we fight for, but we fight for Roses too.

Dr Heath recognised the relevance of the concept of bread and roses in healthcare and, along with another colleague, she wrote:

“Bread and roses are what the humans involved in care – the patient and the clinician (arguably also caregivers and loved ones) – want from healthcare. Bread is sustenance and therefore life; roses are courage and hope, curiosity and joy and all that makes life worth living. Bread is biology; roses biography. Bread is transactional and technocratic; roses are relational. Bread is science; roses are care, kindness and love.”

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A father’s experience

It was late on an August evening that we found ourselves waiting anxiously in the intensive care unit of a children’s hospital more than five years ago. Our dear daughter was not well, she was only nine and fighting for her life in intensive care. The preceding 48 hours had been extremely challenging. There were moments of hope but it was mostly downhill; our dear daughter had been critically ill, she had undergone surgery and was now being resuscitated in the intensive care unit (ICU).

It was past 10pm, we were physically and emotionally exhausted when the intensivist came out to show me a slip of paper. I knew what these blood tests meant. As a surgeon who had managed critical cases for many years, whenever I saw such results I would prepare the family for the worst. Except that this time, the patient was my own daughter, whom I loved more than my own life and who, just days earlier, had been full of life and dreams.

I started to shiver. I knew what was going to happen. No more amounts of “bread” fed to my daughter would have made any difference. I did not know what to say to my wife who had just returned to my side. She must have seen my shivering and the look in my eyes and she understood. “What should we do now?” she asked. The surgeon in me made the fast decisions that I was used to making. “We gather everyone to tell her we love her and allow her to be called home.”

For those last minutes that we had with her, we embraced her and told her in all sincerity that we loved her dearly. It didn’t matter that she was in a state of unconsciousness. In those minutes I remember my sweet girl as someone bursting with life! She saw the world as full of beauty and promises. And in return she was able to show love to the world and the people around her. It is her approach that I still follow. Life is love. Love is life. The brevity and fragility of life are frightening. Yet, love demonstrated in life endures.

Focusing on her life during her final moment with us would become the roses that have carried us through these years. The scent of her life and love continues to live in me and inspire me.

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It’s okay to never ‘get over’ your grief

Death is inevitable, but can we control the fear of it?

Comfort in acceptance

Acceptance is comforting, it is powerful and ultimately liberating. Our very own HealthHub resource describes the stages of grief well. These stages end in acceptance. However, getting to this point may be difficult. I think we all know this and perhaps this is why it is so hard to let go even in the face of imminent death.

In an article two years ago, Dr Daniela J. Lamas, a critical-care physician, described the struggles of letting go when only machines kept one alive. These struggles persist as we have become so skilled in medical repair. Sometimes, the setting may not be critical illness but long drawn-out deaths in which the patients are sustained by tube feeding and piecemeal medical repair. The honest question that one must ask then is: What is the real reason for us to want to keep our loved one going despite imminent death? Is it for the sake of our loved one, no matter the quality of life? Or is it for us? Are we just fighting for bread? What happened to the roses?

The best way to flee a situation enshrouded by death is to embrace life.

As Mdm A lay dying, I started to ask her daughter about her life and what sort of person she was. While providing carefully crafted bread for Mdm A in the form of surgical and critical care, I had yet to appreciate Mdm A as a person.

The daughter’s eyes started to sparkle. For the next 10 minutes she told me about Mdm A, her hardworking nature and her resilience when she was bullied at work. She recalled how Mdm A had given her time despite holding two jobs. She also mentioned a conversation the two of them had had some years earlier, in which Mdm A had explicitly said that she never wanted to become a burden to her daughter.

I put a hand on the shoulder of Mdm A’s daughter and told her it was very clear to me that the love went both ways. I left the daughter alone to have some time with her mother. The daughter spent the following day telling Mdm A how much she appreciated her. It didn’t matter that her mother was unconscious. After that day, she approached me and told me that she had found the acceptance to let her mother go.

For her as a daughter and for me as a father, faced with the impending death of a loved one, roses mattered more than bread.

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Dr Tan Kok Yang is deputy chairman, medical board, and senior consultant surgeon at Khoo Teck Puat Hospital. He is also president of the Geriatric Surgery Society of Singapore.