Wednesday, July 14, 2010

Letting go of the rope

A dear friend of my family is dying. Inexorably, painfully, hopelessly dying. Some days are better. Some are hard to bear. But the eventual outcome is not in doubt.

Along the way, he will have spent a double-digit number of weeks in the hospital, an unknown number of days in a rehab facility, uncounted hours being shuffled between the two, and no time in his own bed. He is finished eating, walking or going to the bathroom unassisted. He has so far engaged eight or ten specialists, and not a single general practitioner.* It will -- has already -- cost a fortune.

This is a man who was a proverbial captain of industry only a few years ago. An actual son of a share-cropper, he worked tirelessly to improve his lot and provide for his family for most of the previous century. He created a thriving business, became a pillar of his church, and a force in political discourse. A generation ago, he's a man who would have died unexpectedly in his sleep, or pitched over into his dessert after a big steak dinner and a couple of martinis. Today, he is a frail, frightened shell of his former self, his body struggling to maintain the minimum requirements for continued existence.

It is the way of life, and American medicine, that many of us will live our final days undergoing every procedure, and receiving every medication, for which our insurance will reimburse the medical corporations whose representatives are working so hard to bring our vital signs back into the range where they may consider the course of treatment complete. There is no talk of cure, or even of going home. Address the current issue, get the patient stable, discharge them from your service, and hope for the best, seems to be the only strategy.

I think the end of life is like water-skiiing. When you feel your balance slipping, you can try to right yourself, or let go of the rope and glide to a stop, more or less under control. The trick is in knowing when to let go. Release your grip too soon, and you may miss a chance to correct and ski on. Hang on too long, and you end up dragged face first through the water, sometimes with your swimsuit floating in the water behind you. It's not exactly drowning -- assuming you let go eventually -- but no one would call it fun.

I've reached the age where I think about these things. Not because I want to, or because I think they are interesting, or significant, or cool.  I think about them because they are happening to people close to me. And because I can feel it in my future, the way we once saw graduation, or marriage, or a new car, just over the horizon. It's all the same journey, but the scenery gets darker towards the end.

Ultimately, hanging on or letting go is a personal decision. Maybe the most personal we ever make. I'm not surprised my friend chose to hang on. It is his nature to struggle, and I always assumed that he would not be one to go gentle into that good night.

For myself, I hope I can be less Dylan Thomas and a little more William Cullen Bryant. Of all the ways we can measure the quality of a life, length is not high on my list. Every story has an ending, and I hate stories that go on too long.

* Because we don't have those anymore.


  1. the age where it's our friends dying, and not just those of our parents.

    i'd like to think i'll let go earlier, rather than later. mainly because i'm not fond of pain and my dignity is worth something to me.

    but who knows? as i spend several hours of each day sitting in a comfy chair, surfing the web for pleasure - perhaps so long as i can read, think and communicate, being trapped in an increasingly decrepit body might have more moments of enjoyment than i can currently imagine.

  2. Having dealt with cancer and life and death issues 26 years now -- starting when I was so young -- I have a skewed perspective. i feel like I have been a scout who has gone on ahead of everyone elsel and everyone is just now catching up to these issues. I hope I don't do a face-plant and let go gracefully. I feel I will know when to do that. I hope I have the option.

    I am so sorry about J. That's not the way to die -- our health system is fucked up and it's up to us to reclaim whatever dignity remains.

  3. I was appalled when I saw one tiny fragile little old lady who was being "treated" last year, when I was ill in hospital. To an outsider, it looked like she was being subjected to an intensly painful operation that would give her perhaps another 10 days - drugged up in bed "recovering" - before being hit by something else. As breathing was about the nly autonomous function she had left, I assume it was her family who were so unwilling to let her go peacefully.

    I'd like to think I'd know when to bow out, but you never know until you've been there.

  4. @daisyfae: I hear you. I never thought I would want to live to be this old, and I'm still enjoying it.

    @Wonder: I know you're way ahead of the rest of this on this one. This is one case where I"m glad to be behind the curve. And I suspect whatever happens, you will find a way to handle it gracefully.

    @Pueblo: I watched my favorite aunt "treated" until she weighed 85 lbs (38 kilos) and didn't even know where she was. It took about six months. That was the first time I resolved to try to avoid that fate, if I could.

  5. Very eloquently stated. However, it is always a bit sad for me when I reach the end of a great story - I always wish it could continue and I tend to read the last lines a bit slower and a bit more carefully.

  6. I clicked over from your comment because I haven't gotten to my google reader for a few days and this post was exactly what I needed to read. I'm going through this weird sort of guilt and pain over my grandmother's state. She seems to have been dying for almost a decade now. They keep saving her. But for what?

    I've decided that I'd rather die early than late.

    It's awful.

    Love to you and your friend and both of your families.

  7. Sorry about your friend. I watched my grandmother and grandfather go that way and it wasn't pleasant. That said, you're depressing the hell out of me over here. I don't have any kids, so I probably think about this more than most. Now I'm going to go stare at my navel and drink a martini.

  8. @D: Understood

    @Lora: Sorry you are having to go through this with your grandmother. It is all too common.

    @JV: Same number of kids. Same transient depression. Same coping strategy. I will try to post something cheery next time.

  9. @chris and J.V. - i've got two kids (23, 21), but i still contemplate my belly button and drink. but i know damn sure they'll not hesitate to take me off life support, so long as i maintain a hefty life insurance policy. so there's that...