Knowing when to stop is an art. When do you know when to push yourself away from the table? When do you know you’ve had enough to drink? When do you decide you’re making enough money, and it’s time to stop climbing the corporate ladder?
If you’re being treated for cancer, and things aren’t going as planned or hoped for, what do you do? If you don’t want to die of cancer, but the disease isn’t responding to treatment, what’s next? Search the world over for a miracle medical trial? Go to Mexico and try a pharmacia advertising miracle cures?
After my second relapse, it was looking like the chances were pretty good that cancer would kill me. A nurse I was working with told me that, at the very least, I had a good quality of life. Maybe in nursing school students are told that’s the right thing to say to a patient in my situation. But it made me angry. I told her, that given my age (35), I was much more concerned about the quantity of my life, than its quality.
A “second opinion” I got was that I was terminally ill (my treating physician told me there was a good chance I was terminally ill). I remember talking to a friend on the phone afterwards. I told her I’d always hoped to be cured. But maybe the best I should hope for was a pain free death. I felt I was in a dark room. Light from beyond an open doorway was in my eyes. But the door was closing, and I couldn’t stop it.
I decided to continue to try to be cured. I’m sure from my “second opinion” doctor’s perspective, I was needlessly bringing more suffering into my life, a life that was soon coming to an end. A life better spent with my family, and not with doctors in hospitals. As turns out, I made the right decision. I’ve been cancer –free (as far as anyone knows) for seven years.
It’s not an easy decision to make. We’re told there’s always hope. Maybe something will be available tomorrow that will result in a cure. We’re told quitters never win, and winners never quit.
For too many people, cancer doesn’t quit either. No matter what is tried, the cancer wins, and a life is cut short. How do you decide what to do? There are some, no matter what they are told, will want to try everything, and anything, to be cured, until their last breath. Are they doing it for themselves? Are they in denial? Are they afraid of letting their family down?
One reason I continued treatment is that, if I was going down, I was going to go down swinging. I didn’t want my daughter to think her Dad was a quitter, because I didn’t want her to be a quitter.
Where do you draw the line? I write many heath care powers of attorney and living wills at my job. It never ceases to amaze me that people specifically request any and all measures be taken to keep them breathing (including ventilators and feeding tubes) even if they’ve been diagnosed with a terminal illness and are in a permanent vegetative state. Do they think machines and drugs will keep them alive forever?
On the other side of the spectrum is a former client of mine, in her 60′s, who was diagnosed with advanced colon cancer. She never attempted any curative treatment. She was resigned to her fate, and made the best of the time she had left. I can still remember the hug she gave me the last time I saw her.
Our medical system is not built to accommodate “quitters”. The incentives are to do more, try more and to keep pushing. But that’s not always the right thing to do.
I want you to read an excellent article in the New Yorker magazine, entitled Letting Go. It’s written by a surgeon, Atul Gawande. It’s about hospice care, and the good it does for many people. Hospice care can not only improve the quality of patients’ lives, and the lives of their families, but in some cases, it can also increase the quantity of their lives. But, as the article states, our medical system can have a hard time dealing with people who’ve had enough, and are pushing themselves away from the cancer treatment table.