by Molly Stevens
When I ask people how they envision an ideal death, they don’t say. “I want to die in ICU, connected to machines, with the sound of alarms piercing my brain.” Instead, they say, “I want to die in peace, surrounded by loved ones.”
I’ve practiced as a registered nurse for 38 years, and I can see it is getting harder for patients to realize this goal.
In 2001 when my mother was in her early eighties, she met with an oncologist to discuss treatment for breast cancer. She had made up her mind she wouldn’t have chemotherapy. I reassured her that in my experience, it wasn’t usually offered to people her age.
Risk vs reward
The doctor validated my observation saying the risks of chemotherapy outweighed the benefits. He supported her decision to undergo radiation therapy as the only adjunct to her lumpectomy. She tolerated it well, and there was no recurrence.
Today it is common for me to see octogenarians undergoing chemotherapy. In my role as a case manager, I ask them if they understood they had a choice to decline it. They say, “We didn’t talk about that.”
I encourage them to evaluate treatment in light of their prognosis and quality of life. But it is hard to abandon the berth once they’ve bought the ticket.
I don’t mean to disparage oncology. And it isn’t the only specialty that races down the aggressive track, like a runaway train.
Why can’t modern medicine face the fact that people die?
Doctors don’t mean to do harm. They want to save lives. And they believe by sacrificing quality of life now, patients will arrive at a worthwhile destination. But this is often a fantasy, destined to fail the moment the train leaves the station.
In his book, Being Mortal, Atul Gawande wonders how treatment decisions would change if clinicians asked patients:
• What is your understanding of the situation and its potential outcomes?
• What are your fears and what are your hopes?
• What are the trade-offs you are willing to make and not willing to make?
• What is the best course of action that best serves this understanding?
After answering these questions, would patients make the same choices? Or would more people limit the time they spend in clinics and hospitals? Do they know there is evidence that terminally ill patients live longer when opting for conservative measures?
In 2007, it was clear my eighty-seven-year-old mother had a severe problem. She had ominous intestinal symptoms and unexplained weight loss.
The critical question
Mom considered diagnostic testing. I asked her the question I wish all providers asked patients, “What are you going to do with the results?” She said she didn’t want surgery, and decided to let nature take its course.
Later, she changed her mind, had a colonoscopy, and confirmed the diagnosis of colon cancer. The gastroenterologist told her the tumor had to come out.
Terror gripped me. I didn’t want my mother to die, but I didn’t fear her death as much as I feared what she would endure getting there.
After three agonizing days in the hospital, Mom opted to go home with hospice. We provided her with chocolate cake on demand, symptom management, and boundless love.
The beauty of a good death
Mom died with Dad and all four of us kids holding her in our arms. I was proud of her, my family, and her medical team. She had the opportunity to ‘die in peace, surrounded by loved ones.’
I have a glimmer of hope for the future with the growth of palliative care, a new medical specialty. But their job is overwhelming. To achieve change, the entire medical community needs to grapple with end of life issues.
In the meantime, I will do my part and ask patients, “If you knew you had limited time, how would you want to spend it?”
Molly Stevens is the award-winning author of the book Boomer on the Ledge, described as “an adult picture book that explores the antics of an aging boomer.” Molly believes humor is the emollient that soothes life’s rough patches and promotes these convictions in her blog: Shallow Reflections. She was the November 2017 Erma Bombeck Writer’s Workshop Humor Writer of the Month, and won third place in the 2017 National Society of Newspaper Columnists writing contest. She is a contributing author for These Summer Months: Stories from the Late Orphan Project, edited by Anne Born.