Monday, July 26, 2010

Terminal Cancer: Choosing not to merely prolong life

I read an article today that took me back five years to probably the most difficult time of my life. Back to a time I when I watched my father die.

Dad was 87 years old and had not been feeling well for awhile. I suspect, longer than he let anyone know. When Dad finally agreed to go to the doctor he admitted that he had not wanted to go because he was afraid that it might be cancer. He felt better about it when the the doctor thought it might be his prostate and ran some tests. But, a week later, he woke one morning and could not get out of bed. The local rural hospital did not know what was wrong and Dad was transferred by helicopter to a hospital in Minneapolis.

It was cancer. Dad had been right. I had not been at the initial meeting with the doctors. My brother called me later while I was at work. The prognosis was that they could not cure the cancer and could only prolong his life. Without any treatment at all he had at most six months to live. The doctors had asked the family to meet the following day to decide his treatment. At that point it was felt that Dad could not make the decision for himself.

I left work that day in tears. A coworker tried to stop me from leaving until I was more in control. But, I just wanted to be away from everyone. I didn’t go far. I drove across the Hennepin Ave Bridge and drove down to a spot just under the Third Ave Bridge. I hadn’t been there in years although it was a favorite spot of mine. Many years before one of my aunts had been found there in the river. I had avoided the area as it was too painful. But on that day I found myself drawn to that spot.I prayed for strength and for the courage to make a decision that I was not sure I could make.

The next day my family all gathered together. All of but one of my siblings were present. My brother who could not be there was represented by his son who had driven up from New Ulm. The meeting was held in my Dad’s room. He was doing much better and was alert and cognizant. Numerous doctors and specialists filed into his room. They discussed the tests, his prognosis and the treatment options to prolong his life. Dad listened and asked questions, but I knew he didn’t understand that the options would not cure him. Both he and my Mom had made sure that we all understood that they wanted no extraordinary methods to simply prolong life.

Dad had initially seemed to agree to treatment. When I looked at my Mom I knew she was surprised. After the doctors left, the family agreed that he did not understand. Dad had poor hearing and wore a hearing aid. We always joked that his hearing loss was “selective.” It was always amazed me that he wouldn’t hear something my Mom would say when sitting next to her, but would hear a conversation while sitting in the next room. My Mom and I stayed in his room to talk to him and the rest of the family waited outside. We talked to him and made sure he understood that there was no cure in the treatment options that had been proposed. They would only extend his life. We were right, he had misunderstood the doctors. A year before a neighbor had died quickly from a similar cancer. He had seen first hand the effect on the family and he wanted none of that.

Dad made his own decision once he understood. First he asked that his primary care doctor be called in so he could ask more questions. The doctor answered his questions simply and directly without all of the medical jargon that the specialists had used. Dad chose no treatment. In his words, “I have lived a good long life, it is enough.”

Dad was transferred to the local nursing home. My brother who could not be there that day took family leave and came home. All of his friends and neighbors were able to come see him. The day before his death each of his children had the opportunity to say goodbye. On his final day he did not wake, but I think he knew we were there. I stayed with him that night and held his hand and I talked to him. Just before midnight I heard him take his final breath. I felt him leave.

I would love to have had more time with my Dad. After five years I still miss him, but I am happy that he was able to make his own decision and die on his terms.


Blogger Madabip said...

“I have lived a good long life, it is enough.”

I love this — your dad's statement and this piece.

July 26, 2010 at 11:48 PM  
Blogger Madabip said...

Just finished the NYorker article. Superb, important to read if you're A) elderly or B) the adult child of an aging parent.

Brought back memories of Mom and Dad. Glad they're out of pain. And glad I don't have to walk that path again.

July 27, 2010 at 9:51 PM  
Blogger azsky13 said...

It had a very strong effect on me as well. I think the key is having the conversation early and often so you know their wishes. But even knowing that, it was still hard.

July 27, 2010 at 10:46 PM  
Blogger sbafarms said...

I went through the same discussions with my 31 year old daughter after she fought Breast Cancer for almost a year. I understand the experience of simultaneous grief and pride in the knowing such wise souls. It has been 8 years since her passing and she is with me every day in a remarkable way. The day before she transformed she made me promise to always remember that everytime I see a butterfly that she is present. Now i see them constantly, everywhere I go. Peace be with you and your family, you have had a remarkable experience, a rare opportunity to See serenity in a loved one. I read something from Rumi every day and never fail to feel her looking over my shoulder. What a beautiful post and perspective. Thank you for having the kindness to share it with the world.

August 2, 2010 at 3:59 PM  
Blogger azsky13 said...

Thank you for your comment. I do consider myself most fortunate for the experience. The one thing I took away was that I no longer fear death. I can still feel my dad with me at different times. I know when he is around because I met his soul when he left. It is a comfort.


August 2, 2010 at 4:12 PM  

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