By Richard P. Holm MD
He was my neighbor, not my patient; a guy my age, a man of many talents and interests, and a dear friend. He was one of those fellows who would give the shirt off his back to help you, if needed. When he was diagnosed with pancreatic cancer which had spread to the liver, he, his daughters, and his friends knew how this was likely going to go. But we didn’t realize how graciously he would handle the dying process until the very end.
My friend was treated with and was truly helped by chemotherapy for a while, but gradually the tumor cells developed resistance to the drugs and the Oncologist suggested no more chemo. My friend was ready to have only pain meds and hospice care. In the end, per his direction and with the help of hospice and the caring people at the Arlington Nursing Home, he shuffled off this mortal coil comfortably, surrounded by his family and friends.
Fortunately, he had a compassionate and grounded primary care doctor and oncologist team who were realistic about his condition and knew when to stop intervention. He also had loving daughters and friends to surround him with support, plenty of ready-to-heat-and-eat tater-tot-like hot-dishes, an advanced directive that said he was not to have any pointless medical intervention, and plenty of pain medicine for comfort. When I visited him two days before his death he told me, despite an expanding belly full of cancer, that he was without pain. Most importantly, he was absolutely unafraid; courageously accepting of the dying process.
In comparison, I find it tragic and too common that patients and families are overwhelmed with a fear of death. Some suggest this disabling-dread comes from our cultural practice of protecting children from seeing death, with the intention of making life easier on them. Thus, a lifelong apprehension and running from death has become the norm. Consequently, we expect modern medicine to save us in the end, which can be a desperate, futile, and harmful hope, especially in an end-of-life situation. What’s more, physicians struggle taking the time and challenge of helping people in denial face their dying process. Bottom line, too many people choose to be dragged through unnecessary suffering at their end of life, and too often doctors comply.
Rather, dying people should ask for and be reassured that enough comfort medicine will be provided and that it’s going to be alright. Our profession has been improving in this regard, but certainly could do better.
When it’s time, we should all have the opportunity for a gracious death, just like my neighbor.