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Facing death

It seems to be getting harder and harder for the layperson to make the necessary, crucial medical decisions only he or she can make. Costs have risen, of course. Ethical questions are more complex. And the growth of scientific technology has made many things more difficult to understand. The voice of common sense, of humane reason, does not come through with the strength we might like.
Not that I have anything against the strides made in medicine. High-tech medicine stood me in good stead in my first brush with laryngeal cancer 10 years ago, and it seemed to be doing well in managing a recurrence that appeared last fall. But suddenly, this April, as I struggled to recover from radiation therapy, all of my energy, appetite, and strength seemed to go. A CT scan confirmed the worst suspicion: a new tumor was growing in my neck between the airway and the esophagus. My case had taken on a new, possibly terminal dimension.

At this point I was in the hospital for tests. The results for some of these were still pending, and my surgeons were due for an out-of-town meeting. The preliminary decision to operate had been made, but the difficult first step — chemotherapy — was at least a week away. “Why not go home”, my personal physician suggested.

Even after only a week or so in an excellent hospital, my going home was a great change for the better. Our bedroom looks west, through French doors and organdy curtains into a growth of white spruce, elm, and silver maple. It was a warm, sunny day when I came home. A faint breeze stirred the green boughs outside and carried the distant voices of the cardinal and mourning dove. Then, into this agreeable, innocent setting came a terribly out-of-place thought: what a lovely place to die.

At first it was neither a totally serious nor a totally frivolous thought, but it was one on which I found myself spending more and more time. After discussing my feelings with my physician, he discontinued my mild antianxiety medication temporarily. Both of us wanted my mind clear and uninfluenced. The out-of-place thought started to settle in.
I began to examine the risks and rewards of the proposed surgery, a difficult and complex choice for anyone, let alone a layperson. My physicians were patient and considerate, desirous of making things open and clear. I finally decided that I would be in for a long hospital confinement, prolonged suffering, and results that would barely justify the risks, assuming the surgery was successful in the first place.

Within our family, the most vocal and articulate supporter of the no-surgery decision was my son-in-law. Both of his parents had died after long illnesses, his father from diabetes-related heart disease, his mother from cancer.

“A long illness eventually destroys the love between people,” he said, “erodes it, just wears it out. That’s what happened in our family. I’ve always felt I never had the chance to say good-bye to either one of my parents. They died in different years, but I think I was the only one in the family to notice they died on the same day of the year.”

Once I decided (and I should say that my wife Georgene and four children joined in the decision) to let nature take its course, the relief was enormous. First to go was the three-times-a-day torture at the dining table. For 7½ months I had been asked ‘to eat’, yet my appetite was nil; swallowing was painful and thickened saliva made chewing difficult. My wife and I would rack our brains each morning to try to think of something that would ‘go down’ that evening. For both of us each day began with, “Oh, God, what will we do about dinner tonight?” Perhaps that doesn’t sound like much, but try the mental strain for 7 ½ months. About this time I also developed sleep problems. I don’t like pills, and I don’t usually take them, except under conditions of injury or illness. The sleeping medicines I used were either ineffective or produced nightmares. I was too tired just to put on the light and read, which is what I used to do.

I am now sleeping well and am in no pain. My decision was certainly affected by an illness’ eventual ability to cause emotional (as well as physical) death. It also set forth an outpouring of love and feeling among all in our family. It established a new level of love between me and my wife, between brother and sister, between half brother and half sister.

None of this is to downplay high-tech medicine. We need every bit of it we can get. But, it can get in the way of decisions that emphasize the all-important human factor.

Sometimes we let the technology of medicine interfere too much with people who enjoy sunny windows.

— Frank D. Campion

(Courtesy : Extract from JAMA, July 28, 1989, p.556.)

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Medical progress


A lovely place to die


Sunny window