‘Good death’ concept slowly gaining acceptance
My wife was very ill; 10 years earlier she had been diagnosed with Stage 3 breast cancer. She underwent a double mastectomy, chemo and radiation treatment. Miraculously, she survived.
Now, she was sick again; we weren’t exactly sure what was wrong. For months and months she had suffered debilitating pain. Following an X-ray one of her several doctors diagnosed spinal stenosis; he injected Barbara with medications to ease the pain; the injections didn’t work. Still, the idea that the cancer had returned never entered my mind.
It had been a long, hard six months or so, and Barbara was in the hospital. We thought she was confused, which in a way she was. She was vague about most things, not deliberately so but as a result of being sick — doctors discovered that her liver wasn’t working, wasn’t releasing the ammonia it produces, and when that happens, we were told, confusion ensues.
But she was clear about one thing: she wanted out of the hospital; she wanted to return home, to the familiar comfort of her couch. She said so, time and again. I told her no; the doctors had more tests to run, I said.
She insisted; she didn’t care about the tests; I resisted. Barbara never did come home. Several weeks ago we spread her ashes in a leafy mountain glade intersected with ponds and a small creek.
More and more I think she was right. She wanted out of the hospital; she wanted no more testing and probing; she wanted to be home.
In a new book, Extreme Measures: Finding A Better Path To The End Of Life, the author, Dr. Jessica Nutik Zitter, a physician trained both in the heroics of death-bed medical miracles and the emerging field of palliative care, argues that instead of “conveyor-belt death” (a patient at times strapped to a hospital bed and administered a seemingly endless number of life-extending medical procedures in the ICU), it is possible to experience a “good death.”
She explained a “good death” involves giving the patient as much medical control as nature allows; death with a minimum of tubes and pain; death surrounded by family and friends and the things one loves.
I don’t know about the “good death” concept: I’m not sure any death — even a sudden one — is truly good. I suspect at the end even 90-year-olds are left to wonder about the brevity of life. For that matter, what terrors race through the mind of a 20-year-old seconds away from earthly oblivion?
But it is possible, I suppose, to lessen the discomfort and the cold institutional rigmarole that is part and parcel of end-of-life medicine. Dr. Zitter’s proverbial conveyor belt is a hellish amalgam of good intentions and the best of medical science, all conspiring to keep the heart beating while the rest of the body is shutting down.
According to Zitter, intensive care has its place. Lives can be saved; some patients, especially the young and otherwise healthy, can emerge to lead full productive lives.
But for older patients laced with cancer, for instance, an ICU is probably not the place to be.
The good doctor is a convert, therefore a fervent advocate. Growing up in a family of doctors, she dreamed of becoming a physician herself. A doctor, her faith teaches, was God’s healing agent. “Judaism venerates the practice of medicine,” Zitter writes. “The Torah glorifies the eradication of disease and the sanctity of life.”
She became a pulmonary and critical care specialist. Then she “performed a chest compression on a dead person” because that’s the way things were done; it was procedure. Dr. Zitter was horrified. There had to be something better, she thought.
She became a palliative care specialist. To many in the medical community, palliative care was weak, unheroic, she says; a palliative care specialist manages suffering “whether physical, emotional, familial or spiritual.”
Pretty flabby stuff, especially when compared to most other medical specialties.
In her earlier role, Zitter says she “never even considered that a dying person might choose comfort as his priority and thus a protocol to descalate the life-prolonging treatments that we steadily heaped on.”
Emerging from the polio epidemics of the 1930s and ’40s, ICUs became magnets for our imaginations and fantasies about the conquest of death. But “our infatuation,” Zitter writes, “caused us to use them indiscriminately.” If machines could save the lives of young polio victims and wounded soldiers, “why not try them on everyone who is dying? And so we did. In the name of hope, heroism and the American way.”
The mantra of the ICU, according to Dr. Zitter, is “keep the patient alive at all costs.” Doctors, patients, families — everyone in medicine and the medical community — all play a role. “We all work within a system,” Zitter writes, “that does not readily support” any other goal or mindset.
Barbara was never admitted to the ICU. The cancer spread rapidly, even though we didn’t receive a more or less definitive diagnosis until close to the end, as mind-boggling as that sounds.
If given a chance, I’m sure Barbara, who wanted to live, who wanted to be around for our grandchildren, for our daughter, for all things that make life worth living, would have chosen to die at our little house in Hopwood.
Maybe that was what she was trying to tell me all those times in the hospital when, with increasing urgency, she begged me to take her home.
Richard Robbins lives in Uniontown and is the author of two books — “Grand Salute: Stories of the World War II Generation” and “Our People.” He can be reached at dick.l.robbins@gmail.com.