From Genshin’s Essentials for Attaining Birth
In the Heaven of the Thirty-Three the pleasures are limitless, but at end of a heavenly being’s life, the following five signs of declining health appear. First, the crown of flowers that adorns her head suddenly withers. Second, dirt and dust cling to her heavenly robes. Third, her armpits start sweating. Fourth, her vision fades in both eyes. Fifth, she no longer feels comfortable in the place she has always been.
When these signs appear, her entourage of heavenly ladies all discard her like a weed and go far away leaving her behind. She lies in the forest crying bitterly and laments, “These heavenly ladies have always been at my side. How could they suddenly discard me like a weed? Now there is nothing I can rely on and no-one I can depend on. Who will save me?”
. . . Though she calls out in this way, no-one tries to help her. The Sutra on the Six Paramitas teaches that this suffering is even worse than birth in a hell realm.