Up & Coming Weekly

THIS WEEK WITH MARGARET THIS WEEK WITH MARGARET by MARGARET DICKSON Walking Down the Last Path One of my oldest and dearest friends, someone I had known since my teenage years, died earlier this year. She was taken ill one Saturday night, diagnosed with several aggressive and late stage cancers the following week, and gone within a month. She did seek treatments of various sorts, but nothing seemed appropriate or even remotely promising for her circumstances. So while she and her family pursued her options, she entered a hospice with gentle and caring personnel who knew how to ease her pain. She seemed comfortable and at peace, and the last week went very quickly. Another friend was also fi ghting a terminal disease at the same time. For a while she did receive treatments which took both physical and mental tolls but which did not arrest the course of her disease. She decided to discontinue her treatments and to resume her usual routines with the people she loved. Soon she felt better and for a while, life seemed normal again. She succumbed in her own home in her own bed without many medical trappings. Those of us blessed to be mothers know that birth is not an event. It is a process. We realize that when we fi rst know there is someone else inside us, when we feel that someone move around in a way no one else can feel, and when that little person eventually leaves our physical selves and takes hold of our hearts. I think the same can be said for our departure. It is a process, not an event. And just as each birth is unique, so is each departure. No one can predict how or when it is going to take place, but there are certain choices to be made along the way that can shape the process of leaving. None of us knows what choices we will make when they are presented to us, but I found lessons in the experiences of my friends. One friend did not receive treatment because there apparently was none. She spent her fi nal days with family and friends, watched over by professionals who understood the process she was going through and who offered her both comfort and realism. My other friend made a decision to live what life was left for her without the side effects of medical treatment even though it could have prolonged her life to some extent. In effect, she chose quality over quantity. Maybe because of the still-fresh experiences of my friends, a recent newspaper article caught my attention. Writing for the Associated Press, Marilyn Marchione talks about Americans facing terminal illnesses — what we say we want and what actually happens. For all sorts of reasons including our high standard of living and various safety regulations, 80 percent of us die not from accidents or epidemics that beset much of the rest of the world, but from long, progressive illnesses like heart disease, cancer and Alzheimer’s. 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Studies tell us that hospitalizations during the last six months of life are up, while at the same time the average time patients spend in hospice care is falling because people are entering such palliative care very late in the process. This is true even though the price of many medical treatments in dollars is staggering and the toll on the patients and those who love them can be tortuous. Almost a third of all Medicare dollars are spent treating illnesses in the last two years of life, and many of us have watched in what can only be described as horror as someone we love lies in a hospital bed presided over by machines. Dr. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center puts it this way. He says that many patients and their families simply do not want to give up and that the treatments can actually be worse than the disease. To families who seek aggressive treatments, Dr. Byock says, “there are worse things than having someone you love die.” The doctor’s words shocked me the fi rst time I read them, but I know there is truth there as well. I have no idea what decisions I will make when I reach this last fork in the road, but I am going to talk about the possibilities now with the people I hope will be with me. I am also going to ask them what choices they would make for themselves. Lawyers will tell you to record such choices in living wills and powers of attorney so that your wishes for yourself are known and can be followed, and I am going to check which of my loved ones have these and try to nudge those who do not. None of this changes anything about our departures, but it can make the experiences richer for us and for those who love us. MARGARET DICKSON, Contributing Writer COMMENTS? 484-6200 ext. 222 or editor@upandcomingweekly.com. 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