He was my neighbor, 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 cancer of the pancreas spread to 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 his dying process until it happened.
He was treated and truly helped by chemotherapy for a while, but gradually the tumor cells developed resistance to the drugs and the oncologist suggested no more chemo. He was ready to have only pain meds and hospice. In the end, per his direction, with the help of hospice and the caring people at the small-town 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 and knew when to stop intervention; 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 medical intervention if pointless; and plenty of pain medicine for comfort. When I visited him two days before his death, despite an expanding belly full of cancer, he told me he was getting enough meds and was comfortable. Most important, he was absolutely not fearful but 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 covering up death with the intent to make life easier. Thus, a lifelong apprehension and running from death has become the norm.
Bottom line, too many people choose to be dragged through unnecessary suffering at their end of life, and too often doctors and nurses comply. We could do a better job stopping unnecessary medicines, touching our patients more and providing comfort to not only the patient, but to the patient’s family as well.
Dying people have the right to ask for and be reassured that enough comfort medicine will be provided and that it’s going to be all right. Our profession has been improving in this regard, but certainly could do better. When it’s time, it’s important that we all have the opportunity for a comfortable death, just like my neighbor.
Richard P. Holm, MD is currently living with pancreatic cancer. He is founder of The Prairie Doc.