According to a study recently completed by the Massachusetts General Hospital (reported in The New England Journal of Medicine), sometimes the best strategy for treating an illness like advanced-stage lung cancer is to do nothing. Or, at least do nothing except provide palliative care, i.e., ameliorate pain and symptoms so far as is possible, but for the most part, forego chemotherapy regimens, that, in advanced non-small-cell lung cancers, have virtually no hope of curing the disease and according to the study, accelerate the demise of the patient, on average by about 2.7 months. Not only do patients that are provided palliative, instead of therapeutic care live longer, they enjoy their remaining days more than do the patients suffering the effects of chemotherapy.
This is significant, even if, like so many studies in medical science, it represents an attempt at quantifying what any reasonable person should already well know. It’s not quite on par in that realm with a study I read the other day that surmised (surprise!) a link between obesity and Type II diabetes, but its conclusions are hardly shocking.
In this death-denying, materialistic culture in which we live, it is not surprising that we often treat the fatally-ill with therapeutic medicines which we know provide no hope for cure. It’s as if admitting and accepting one’s ultimate demise is to be avoided at all costs. As soon as the inevitability of death is admitted, the dying become like the lepers of old, shunned and avoided. Death with dignity doesn’t exist. The fatally ill have to go down fighting like mad, eagerly clinging to every cockeyed idea that medical science might conjure in trying to extend life here on earth.
It’s a function of the vulgar materialism of our culture. Nothing matters except what we can see and touch and taste and feel. We find our spirituality in things; our continued earthly existence being the one material thing we cherish most of all. We know, yet refuse to admit, that each life brings a death. Denying death is the ultimate luxury in a culture besotted with money. We waste vast resources on indulging our fantasies that death is defeatable. The luxury of indulging our death-denying fantasies may well bankrupt us.
As St. Augustine observed many years ago, clinging to things that can’t be possessed without the fear of losing is a fearful and meaningless way to live life; it in fact is a life that is better described as death. Our earthly existence, no matter how long it lasts, is destined to be just a speck in the eye of eternity. We only truly live when we disregard death, and focus on possessions that we can enjoy without the fear of losing.
When my son was diagnosed with relapsed leukemia about a year ago, I then and there knew and accepted that he would likely die of the disease or its complications. It had been eight years since we thought a bone marrow transplant had cured him of the disease, but relapsing meant he had a very grim prognosis. His cancer doctor, whom I grew to like and tremendously respect over the years, said he thought another bone marrow transplant could cure him. I thought but didn’t say, out of consideration for all he’d done for my son, “Yeah, cure him like the last one cured him?”
We reluctantly agreed to go ahead and try. Though I didn’t much believe it would work, how could I object to their wishes? He was only fifteen years old. Had we not done everything possible to try and save him, would I have been able to live with myself? But a bone marrow transplant is itself a life-threatening condition. The drugs used to kill the bone marrow and any remaining leukemia are poison. One in fact, busulfan, is derived from the same compound as mustard gas, used in World War I by the Germans against the Allies.
“Life-threatening” is basically what happened. Six weeks into the transplant, on Christmas Eve last year, my son’s kidneys had failed and his liver was going. They were planning to push him down to the intensive care unit from the transplant unit, so they could do continuous dialysis and see if that would turn his condition around. But they also came and dialyzed him in the room that day, to see if his liver functions would improve without needing to go to the ICU. If we were to go to the ICU, it would be about 3:00 am, after the 2:00 am labs. I can’t imagine anything more depressing than arriving at a hospital ICU at 3:00 am.
I was distraught when his condition became so critical that it appeared the bone marrow transplant itself would kill him. I felt like I had betrayed him, mortgaging his last good days on earth for the ephemeral hope that there was a viable treatment with the possibility of a cure. I felt I had let him down. It wasn’t that he would die–I never kidded myself into believing he wouldn’t. It was that I had allowed the doctors to inflict untold pain and misery on him for naught. He had been in remission at the start of the transplant. There’s no telling how long remission might have lasted. At least so long as it did, he would have had better days, had we not attempted a transplant.
It turned out that he didn’t have to go to the ICU. His liver got better from the dialysis that day, and steadily improved from there. His kidneys eventually came back around, too. And after suffering from weeks of intense bleeding in his bladder, he finally got over that, too.
But I harbor no delusion that he’s cured, or that he will survive this. All I know is that we have now done all that medical science has to offer in extending his life and there’s now precious little point in worrying over whether it will work. He’ll survive this relapse or not. It’s between him and God. Worrying over it would just make my life and his a bit more like a living death.
In the meantime, he’s back at school and hanging with his friends and spreading his wings with a fresh driver’s license. He takes things one day at a time. So do I. There is an eternity in each moment, just asking us to grasp it as our own.
Ultimately, all care is palliative care. There is no cure for life. We must learn to embrace our imminent death so that we can enjoy the life that causes it. I bet those lung cancer patients that chose not to take chemotherapy died as they lived–gracefully–which is one of those priceless things that can be possessed and cherished without the fear of losing.