I grew up having what I believe to be a pretty realistic view of life and death. It is something my parents were very open and honest with us about. My mom was a hospice nurse, taking care of people in their last 6 months of life. My dad's mother, my grandmother (and my namesake), lived with us when her health started it's final decline. And I always remember (although I dont know that I could have put words to it at the time, although I sort of did with my poetry), that there was the sense that death was imminent, but that it was not something to be fought with.
That is an ethical issue I deal with a lot in work these days. While some of my patients are very realistic with the fact that death is a part of life, some want to fight it tooth and nail to the end...Even after they have done everything, fought with every weapon we have, and their cancer is still spreading, they want to be in the hospital, getting another surgery, or more radiation, or whatever...Fighting tooth and nail to the imminent conclusion. And sometimes they stroke out their brains, and their families want to keep them on life support indefinitely, even transporting their lifeless bodies to ventilator facilities, where the shell of what they once were lives for years by the machine. And I have a hard time with this. It is hard to not impose my own values on things. But I think in the US, we have this false sense of control over things that makes us think that we even have control over our own deaths. I still think death is just a part of life, and sometimes you just have to accept it. I think sometimes you have to allow it to be a beautiful, if not heartwrenching thing. If i were dying, of course I would accept treatment, but if it became apparent that it wasn't working, I would want to spend my last days with the people I loved, at home, or the beach, or whatever, rather than in the hospital trying to cheat off death. That is why I love hospice care.
I even hate that we use the word "fight" when we talk about cancer. I understand that the treatments are draconian and terrible, and you need to have some sort of mentality like that to get through it. At the same time, if you "lose" that battle, what are we saying? That the patient just didn't fight hard enough? That they were defeated? Are we calling into question the person's strength and character when they really entered a battle they couldn't possibly win?
THis weekend I am in Bakersfield to say goodbye to my aunt who is dying. I am glad that I have the opportunity to see her, and the warning that the inevitable is imminent, often when we lose people we are not so lucky. I am sort of nervous to see her, I know she will not be the aunt I remember, and her body will be wasted. I am wondering if we will talk and acknowledge how sick she is, or if we will avoid it, carry on as if it is business as usual, and ignore the elephant in the room.
My life is so compartmentalized and crazy, I don't know that I have dealt with the fact that she is dying, other than when I am post call and exhausted, and every other defense has been worn down and I have been reduced to the emotional capacity of a small child...I know when I see her tomorrow, it will be real and in my face. And I hope that I can recognize the beauty in this process, even as my heart breaks. I hope that I don't do what the world does - ignoring the uncomfortable, ignoring the depths. I hope our hearts can be out there in the rawness of the coming passage. But at the same time, I wonder what she needs, if she needs some "normalcy."