Journal of Palliative Medicine

I wonder what it will take for the ‘pause’ required to hear this message.

Recently a friend had a surprising diagnosis of stage 4 lung cancer. When he got pneumonia, ended up on a ventilator and was flown to a higher level hospital, his family wrote on face book “He needs to get well so he can continue his fight.” Okay. As I watch, he continues to decline, now in his second round of Chemo.

Well, it’s a choice — but is it really, when we offer nothing but inane battle ground up for consideration?

What if we were honest with the patient and family; informing them how long the patient is likely to live with our without treatment?

Would patient and family choices be so misguided if we told the truth rather than giving them the default ’6 months’ to live? They told me that and my husband actually lived for 17 days! Thank you very much for not helping us know our own truth.

What if we informed patients and family whether treatment would be beneficial or harmful, and helped them to see whether a treatment choice would help them accomplish what they want to do in their remaining time?

What if we considered whether the treatment choices were cost effective? What if we asked them what they knew in their gut or heart?

What if we asked more questions, instead of thinking we have the answers?

Sadly, our society promotes life at any price and so ends up prolonging death. I intend to do all I can to keep my life, but want the power to stop efforts to prolong my death. Thank you for this.

Thanks Marian. I think this is a very important issue. As I Palliative Care physician, I work with this on a daily basis. People do seem to need powerful metaphors with which to understand their experience. The battle or fighting metaphor is deeply flawed, particularly inasmuch as it makes ‘losers’ out of people that succumb to their illness;i.e. all of us. I watch people stuck in this thinking subjecting themselves to almost worthless and toxic therapy in order to maintain their identification with being a fighter that never quits. In my encounters with patients and families, I confront this directly in an effort to empower them with a more appropriate way to wrap their head around what’s happening to them. I like to talk about life as a journey that is ours to create with our choices. Throughout life, we come to forks in the road at which we make a choice. From that choice, the path unfolds and we advance through the adventure of our life. We know how to do this…that’s how we got here. Some good choices, some bad choices. Always moving forward. The journey through illness is no different and we have everything we need to find our way through wherever our path allows. It requires us to be firmly related to the reality of our situation and clearly informed of the available choices. Then we choose. Another metaphor, for the right people, is that life is a dance. We listen to the music and we move intuitively,as an expression of who we are. For those that are deeply identified with the battle metaphor, I often deconstruct the simplistic fighter that simply fights and fights and fights. I expand their view to consider the nature of a ‘warrior’. Never foolish and always strategic, a warrior never rams his head into a brick wall. Rather, they take stock and intensifies his perception to understand the obstacle from a new perspective. Sometimes looking for a way around or over the wall, and sometimes carefully redefining the nature of success. In the case of advancing illness, redefining the nature of healing and completion with grace and bravery. Our society requires new ways of understanding many things. Dying in power is one of them, as is living fully throughout the miracle of our existence.