At Peace: Choosing a Good Death after a Long Life
Samuel Harrington M.D.
The issue is control. You cannot control everything, but you can control some things.
If you decide that you will focus on staying alive for as long as possible, then the fighting and the dying will probably hurt and hurt a lot. You will risk a period of being held in life by medications, wires and tubes. Depending how grim your determination and probably more to the point once you enter semi-consciousness, how grim the determination of those around you to not let you go, you, or what is left of you, will suffer.
I was on the edges of my mother’s death, my sisters in the center. So as she lay in the hospital bed, I showed up from time to time to wait helplessly for whatever the process was to be, knowing that the big decisions were being made without me. That was fine. I had left home for the seminary in my thirteenth year and the three of them, thirty years later, were a tight unit.
On the one hand the set-up looked like a place seeking a cure. Tubes and machines and wires some connected and others at the ready. On the other hand the doctor substituting for her regular doctor told me that she was bleeding from “some place” in her intestines. He seemed uninterested in “where” or in doing something to stop it. I thought that he wanted to call the battle ended and within a few hours, he did precisely that, and in a short time Ruth died.
I learned just recently that, on his return, Ruth’s personal physician bemoaned his absence because he could have done some things to gain Ruth more time. My sisters sharply challenged him, things had gone perfectly well without him. Our mother needed no more suffering.
Dr. Harrington and his book, At Peace: Choosing a Good Death after a Long Life, gives you a look at the issues you will face in the dying process and prepares you for the decisions you will be forced to make, or will make by not making.
He starts with the American dream, and the dream of American medicine, that we can do anything. Who enters medical school imagining that they will spend time easing the way to death? Do not the daydreams of the future for most end with the patient cured?
A friend of mine was diagnosed with cancer of the spine. Since he was well beloved by many in the Minneapolis business community soon in the skyways of downtown appeared a Pelican symbol on the lapels of many of the blue and gray suits of the executive ranks. They were praying for Dick. There were even prayer groups formed. At one point an email went out from Dick’s home announcing the prayers were working that Dick was doing fine, he had reached the median point of the trajectory towards death and he was still alive. There was hope he could beat this. In a week, he was dead.
Dr. Harrington says that most of the time that is what will happen. In the prognosis, the median is the most likely result. That is why they call it the median. There is a world out there that finds death unacceptable. I need to make my own decision, about what I will accept and not accept. I will be doing the suffering. This decision is not an open and shut case. That is my take-away from At Peace. There are decisions to be made. I will not just flow with the tide.
There are many useful messages in the book. For instance: Hospice is free and a big help, sign on early. (Most of the time hospice comes to you.) Gathering the family to talk this through will save hurtful battles between them when you cannot speak. It helps to know what the dying process looks like, and the book will list several disease-specific dying processes. It helps to know what happens when you refuse food and fluid. It helps to know what medical directives you want on file and where you want them on file. It helps to know what will happen when your heart fails and you have not directed “no resuscitation.”
It helps to know that some day this vibrant body that is you may be completely dependent on what has been said before, your consciousness blocked from communication with those who are caring for you.
One of the funniest stories in the book is directed at the attitudes of oncologists. I tried it on lay people, who thought it hilarious. I tried it on medical people, who thought it funny but laughed with hands over mouth. I tried it on my own doctor who thought it not funny at all. After several moments of silence she said, “You must know a different set of oncologists than I do.”
So the situation may not be as bad as Harrington paints it. You may find your medical team trying to inform your decision and leaving the final decision to you and yours. In that case, having read At Peace, will allow you a more intelligent place at the table.
This book goes on my shelf for “when the time comes.” When the pieces start coming off I will really need its guidance. For now, I am pleased to have familiarized myself with its issues. Consider it for your reading and your reference shelf. The large and complete index may some day prove helpful.