Wednesday, April 29, 2009

Dying Well

My aunt died yesterday morning. I was not particularly close with her, although she had always been pleasant enough to me when growing up (I don't think I have seen her in over 20 years) and I have generally fond memories of family gatherings as a child with my mother's side of the family.

She died of metastatic lung cancer that had been diagnosed just about a year and a half ago. She initially opted for radiation and chemotherapy, but after several months of treatment with typical complications, she had decided not to try to "beat" the disease and focused on getting her affairs in order before she died. (One such complication, typical of the kind experienced by cancer patients, was that the radiation to her tumor at the top of her lung also affected her esophagus, creating ulcers that made it exquisitely painful for her to swallow, requiring her to be fed intravenously. When she understood that "curative" treatment would mean months of IV feeding, or would require "tube feeding" in which a tube would be inserted from her abdominal wall directly into her stomach to provide her with nutrition--and that all of these measures would not necessarily ensure success--that was the final straw for her.) She invited all of the female members of her extended family as well as close friends down to her place just under a year ago for a "celebration of life"; my wife and daughter, who had never met her, flew down and by all accounts it was a wonderful weekend. As the months passed she continued to do relatively well, but by the winter the tumor had metastasized to her brain, and she declined gradually over the past several months, entering into a coma less than a week ago.

During the past few months she was cared for in part by hospice workers, but largely by my other aunt, a pediatric ICU nurse who fortunately is quite familiar with caring for the sick. Other family members provided what support they could by visiting or helping financially. My mother, who had just attended her granddaughter's bat mitzvah ceremony the week before, flew down to be with her sisters until the end and say goodbye.

She died in that comatose state yesterday morning, of what I assume was uremia (kidney failure). Her body had been gradually shutting down, and her descent was peaceful. Yesterday I spoke briefly with my mother, who was not surprisingly upset to have lost her younger sister. With that understanding, I did explain to my mother that my aunt was remarkably fortunate to have died a death, virtually painlessly, surrounded by her family, in her home, and got to say goodbye to those who cared for her. They were all very lucky.

I had another aunt on the other side of the family with whom I was closer, who died about ten years ago from ovarian cancer. Almost to the end she was determined to fight the disease, and consequently suffered unbearably even when, from my point of view, it was clear that she would succumb. In the end she did die at home, but was in considerably more pain because she had not sought hospice weeks or months before when they could have helped her. She died within the same year that another woman, the mother of one of my college roommates and a woman who has come closest in my life to being something approaching a surrogate mother-figure for me, had also died of ovarian cancer. Like this other aunt of mine, she had refused to accept defeat, and the unfortunate consequence was her dying while being coded by total strangers in an ICU, and never having had the chance to say goodbye to her four children or husband.

Their deaths have gnawed at me over the years as I loved them both.

I write this not out of anger but perhaps a certain disappointment in the values that we hold that lead us to such decisions. My mother's sister, by contrast, was in an enviable position considering the hand she was dealt. She died a good death, and though I wasn't much of a nephew to her, as a doctor that is one of the highest compliments I can pay her on her passing.

PS--There is more to be said about The Influenza--much more--and I hope to be back in the next few days with further observations.

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