My friend Chris V. (whose blog is Candid Canine) sent me a very timely article she came across on Yahoo!News: Americans are treated, and overtreated, to death.

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.

Over the weekend I found out my aunt’s cancer is back. It’s a blow I’ve been struggling with ever since. (And in part why I needed a restorative movie weekend to get my mind off Real Life.)

I really wish I could remember when she was first diagnosed. I want to say September 2008. I know it wasn’t terribly long after my mom passed, nor was it terribly long before I discovered mine.

My aunt (Alice Kotso is her name if you care to send love and light her way or keep her in your prayers) is a rare breed of woman. On her outside she’s as coiffed, polished as poised as they come. But inside she’s tough as nails. There’s not much that gets passed her, and not much she’s afraid of.

If anyone could beat cancer into remission, it was her. But she was always afraid her cancer treatments would affect her already existing health problems. She reluctantly agreed to chemo the first time around.

This past May they found another tumor. They operated and told her she needed chemo again. She refused. They suggested radiation at the very least. She refused again. She said she was putting it in God’s hands. She left for a three week trip to China with her husband, but instead of getting better she only got worse.

She had ovarian cancer to start with. She now has leukemia, which they suspect was caused by her initial cancer treatments. The very thing she feared most happened.

Now the cancer has now spread. They’re running tests to find out if it’s the ovarian or the leukemia that’s spread. They’ve basically said it’s definitely terminal, but there may be some kind of treatment to slow it down.

Except she doesn’t want to do it. It’s not that she wants to die exactly. As she tried to explain it, she’s 75, she’s lived both a very full and blessed life, and if it’s her time to go out she wants to go on her own terms. She already experienced the indignities and hardships chemo brings. She doesn’t want to put her body back through that. Nor does she want to be treated like a sick and dying person.

I respect that. Chemo sucked. The first two treatments weren’t too bad. The last four almost killed me. Or that’s what it felt like. Uncontrollable throwing up. Shitting myself. Having so little energy just trying to eat a couple of spoonfuls of soup used up so much energy I’d nap for three hours.

She had it even worse. She had to have a blood transfusion when her white cell count fell too low. And losing her hair was a devastating blow. She’s always been a beautiful woman who prides herself on her vanity. Suffering the indignity of her looks being totally robbed from her was much harder on her psyche than it was on someone like myself who’s never known what it’s like to have looks matter like she has.

Sunday I was pretty torn up about it. Mostly because she’s the only one who understood what I was going through. Even after I hit remission I confessed to her that I, too, feared the future. The day when I might not start feeling quite right again. Or worse, feeling just fine but on a check up visit being told “It’s back.”

She understood the anxiety that gradually starts escalating about a month or so before the next scheduled check up. She understood the mood swings and impatience with “healthy” people. (Meaning, non-cancerites.)

Better than anyone she understood me ranting about how we get this one shot at life, and, yes, you can go at any time. In a car accident, being in the wrong place at the wrong time and being done in by some wacko on a shooting spree. Or maybe just having a massive heart attack.

Those are terrible, sudden ways to go. But learning you have cancer is worse. I was so, so, so lucky to have a kind that could not only be treated, but potentially cured. I’m not fully cured though yet. I won’t reach that status for another 4 years –if I’m lucky.

Aunt Alice understood that. She was in the exact same boat. She’s now transferred to another one. One we’ve both been made painfully aware exists thanks to others sharing their cancer horror stories.

Like her good friends who lost their son after his brief battle with pancreatic cancer. He lived maybe four months after being diganosed.

Or our neighbor who just lost his brother. He’d gone to see the doctor because he was constipated. He thought he’d get an enema or something. Wrong. He, too, was diagnosed with cancer. A late stage one. He was immediately referred to hospice. Just two weeks later he succumbed.

There was also the lady at tennis. Her sister went in for fatigue. She’d been stressed, working hard. She expected the doctor to tell her she needed a break. Nope. End stage breast cancer. Three weeks later she was gone. She had just turned 37.

It can happen that fast. And when you’re confronted with that kind of death sentence, even if you get a bit of a stay like myself, it changes everything.

People often tell me having a baby changed how they viewed the world. That’s what cancer’s done for me. My aunt is just another example and reminder to myself that I’m living on borrowed time at this point. Maybe my stay will become a full fledged pardon and it won’t be cancer that takes me out.

I don’t know. All I do know is I can’t take anything for granted. Not my health, not those I love, not my passions, and most of all not my Authentic Self. My life has to honor that and be a tribute to all those who’d love to have their lives back and chance of fulfilling their heartfelt destinies restored.