Americans increasingly are treated to death, spending more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies.
That was just one of the snippets from the article that resounded with me. The other was an anecdote about a 32 year old woman who’d been diagnosed with an incurable brain tumor. She’d undergone two surgeries, chemo, plus radiation. She spent months in the hospital, finally being released and able to spend time with her family, including her two year old daughter, before she died the very next day.
A stunning number of cancer patients get aggressive care in the last days of their lives, [Dr. Martha Twaddle] noted. One large study of Medicare records found that nearly 12 percent of cancer patients who died in 1999 received chemo in the last two weeks of life, up from nearly 10 percent in 1993.
Guidelines from an alliance of leading cancer centers say patients whose cancer has spread should stop getting anti-cancer medicine if sequential attempts with three different drugs fail to shrink their tumors. Yet according to IntrinsiQ, a cancer data analysis company, almost 20 percent of patients with colorectal cancer that has spread are on at least their fourth chemotherapy drug. The same goes for roughly 12 percent of patients with metastatic breast cancer, and for 12 percent of those with lung cancer. The analysis is based on more than 60,000 cancer patients.
The Woman in the Room Across the Hall
When my mom was in the hospice the woman in the room across the hall from her was young. Forties.
When my mom first was checked in the hospice that lady was vibrant. Her room was decorated with pictures, flowers, all kinds of neat personal knicknacks. Friends and family often were with her, laughing and playing games. You’d never have known the woman was dying.
The next week her door was often closed, a note posted on the door: “I love visitors but please limit visits to 15 minutes. My energy is down today.”
The next week her door was closed, there was a book on a table outside her room, and the note on the door said, “Unable to see visitors. Please sign my book so I know you were here. I appreciate you stopping by.”
I’m not sure when she died. That’s when my mom took her turn. But I sure admired that lady. I often found myself thinking, “That’s how I’d like to go out. If I have a chance, and know the end is coming, that’s how I’d spend my time. Celebrating my life with the people who’ve touched it.”
The American Way
I’ve really been struggling with my aunt’s diagnosis. But this article Chris sent today helped me understand in part why. (Besides the obvious reasons.)
The American way is “never giving up, hoping for a miracle,” said Dr. Porter Storey, a former hospice medical director who is executive vice president of the hospice group that Morrison heads.
“We use sports metaphors and war metaphors all the time. We talk about never giving up and it’s not over till the fat lady sings …. glorifying people who fought to their very last breath,” when instead we should be helping them accept death as an inevitable part of life, he said.
I’ve really struggled with my aunt saying, “You know what? The time for treatment is past. I’m going out on my own terms.”
I am most definitely American through and through with respect to the “fight to the bitter end” mentality. Ain’t no way I was going out without a fight.
But I also had hope. If my treatments worked I might just be cured, and the odds were in my favor for that. If that had not been the case…well, I still would have fought. I would’ve held out hope for a miracle.
But now? I still might fight. I’m still young. I still have a lot to do.
Not Quitting, It’s Transitioning
But if I went through aggressive treatments, the tumors didn’t shrink, or, worse, spread, I’d opt to spend my last days peacefully. No needles. No drugs. (Except ones to keep me comfortable.)
Comfort. That’s the key. If I’m lucky enough to have the luxury of knowing my estimated end date, I think I’d do like my aunt. I’d opt for comfort. And a higher quality of life and goodbye time with my loved ones.
Because, lucky for my aunt, right now she’s not in much pain. She just wants to enjoy her kids, grandkids, and her husband during the time she has left. Running to doctor appointments, hospital time, dealing with treatment side effects…it sucks all the good time away.
Like she has all her life, my aunt is living –and now dying– with her trademark style and grace.
This article really helped me put some things in perspective. Chris, if you read this, thanks again for sharing it with me.