"To be or not to be, that is the question," Hamlet articulates in Shakespeare's play "Hamlet." We can reword this question for those of us in the grip of the medical industrial complex: To die or not to die, that is the question. We have achieved the capacity to stave off death and we are encouraged if not deeply persuaded in our most vulnerable state to do so. In stark and honest terms, what we have achieved is the capacity to be in our dying time more than once in our lifetime. Is this an achievement, or some kind of perversity of what is asked of us as mortal beings?
I have two stories to tell. They are about death knocking at one's door and two different answers.
I was asked to visit and speak with a family that is grappling with what to do. P., the husband, had been diagnosed with lung caner and was being treated with standard chemotherapy. Recently, he found out that the cancer has spread to his brain and other parts of his body. In other words, his condition is terminal and he is in his dying time. Through a chain of connections, they were led to a doctor who offers a combination of chemotherapy and immunotherapy for patients with advanced cancer. The doctor is sure, given P.'s genetic make-up, that he can save him. It is still not clear what that means in terms of remission, and if so, for how long, and the side-effects from the treatment. The doctor's location is nearly three hours from P.'s home. As it is, just walking from his bed to the living room is an enormous effort.
Questions about costs that are not covered by his health insurance and the expense of staying close to the doctor have not been completely addressed yet. This family is struggling to have hope, to believe the doctor's claims, and with the "pragmatics" as P. puts it. They are not well off financially and they have young children to consider.
The second story is about my husband who was diagnosed with metastatic pancreatic cancer. Of course the oncologist offered chemotherapy though the potential months or years bought was not a guarantee.
This, if fact, is what is common about these two stories: The doctors cannot give a guarantee.
My husband was in his dying time and his shocked reaction was to try anything to prolong his life even though the science and statistics were gravely against his survival. He did not take well to chemotherapy and it became evident early on that his quality of life would suffer with treatment. He stopped chemotherapy, went into hospice care, and managed to live while dying. He had goals that he wanted to accomplish like conducting his last concert (he was a choral director) that he did achieve thanks to the medical director of hospice. His death was ultimately peaceful. One of acceptance.
In reality, there was nothing to offer my husband given his stage of terminal cancer. But, the oncologists would have prevailed if he had agreed. He, according to them, was so young and other than terminal cancer, so healthy. The upshot was that he had no choice except to die of his disease.
Back to P., to die or not to die. He and his immediate and loving family are almost paralyzed by the choice to trust this doctor to miraculously extend his life with quality. How can they say no to this? How can they not wage the bet, go through their life savings, and give it a shot?
My husband did not have this dangling carrot. But, he did have some living to do while death was knocking at his door.
Deborah Golden Alecson is a death, dying and bereavement educator and speaker who resides in Lenox, Mass. She is the author of three books that deal with her personal loss. Learn more at www.deborahgoldenalecson.com.