I would like to share a story that was shared with me by a family member of a long-term patient of mine. In my opinion, it is a story about a good death. I don’t know if my patient considered her own death a good one. I hope she did.
I met JH five years ago. She had been diagnosed with metastatic rectal cancer at the age of sixty-six. Her cancer was curable at the time. She received what was typical curative intent treatment with pre-operative radiation plus chemotherapy followed by surgery followed by a little more chemotherapy. She also had part of her liver removed to take a spot of her cancer out which had already spread. She did well for the duration of her therapy plan which lasted a little less than one year.
Not long after JH finished this treatment, a CT found recurrent cancer in both of her lungs. The distribution of her disease did not allow for curative surgical lung resection. I had to tell her any treatment we attempted from then on was palliative in nature.
For the next three years, JH came and went from the cancer centre frequently. She had a long run with the first palliative chemotherapy combination we tried. Her cancer would respond and shrink down a little. Then, she would want a short treatment break to recover from some of the side effects she was experiencing. She would take her break and weeks to a few months later we would resume her chemo, and so on. She struggled a little with tiredness but the breaks we took always seemed to get her back to her typical baseline fitness level. She was still working on the farm she lived at and contributing to her community.
A few years into palliative treatment, JH started developing bony pain. Her cancer had spread to her spine and ribs. She received focal radiation treatment for the painful areas which helped for a period. Pain medication was also effective. But after a while, her pain became debilitating, even with the use of the narcotics I prescribed her.
The last time I saw JH in clinic she was with two of her family members. I got the sense her family still wanted JH to fight, to try whatever I could access to see if it might help her now galloping-along cancer. I looked JH in the eyes for a long time that day. I told her it was okay to say no to treatment. I told her she was allowed to say stop.
As I watched JH to see if she had an answer about what she wanted to do, she was looking hard back at me. We talked about the pros and cons of trying to find something else to treat her cancer with. We compared further treatment to focusing only on pain and symptom management.
Her eyes told me she was finished before her voice did.
I often find my patients just know. They know when their body has had enough. They know when they don’t have any fight left. JH had this look in her eyes – a look that told me she was at peace without saying a word. She knew.
When she finally used her words, JH said she was ready to stop. She said only God knew when her time was up, and she trust Him. She thanked me for taking care of her for all these years. She said, “we did good, you and me”. I told her it was she that had done well . . . better than expected.
Truth be told, I thought JH had another two or three months left in her. I presumed she would be able to share some more time with her family. I heard from her sister about ten days later. This is the story her sister shared with me:
“She was so tired, Dr Spratlin. So tired. For the last few days all she did was lie in bed. We would help her up to have a few bites of food or sips of water, and of course help her to the bathroom, but otherwise she was just in bed.
On Friday her breathing changed a little. A bunch of us gathered in her room at her bedside. We just sat and talked and shared stories. JH didn’t say much but she didn’t mind that we were all there. You know some people in pain don’t want to be around others, but JH was fine with it. She welcomed the company.
She would take a breath and then not breathe for what seemed like a long while. And then another breath. And then nothing. It was like that for a while.
And then she was gone. She was just gone.”
I told JH’s sister it sounded to me like a beautiful death. I thanked her for sharing JF’s final moments with me. She agreed JH had a beautiful death. I wish this kind of death for all my patients. It’s comforting for me to know that it at least happens some of the time.
There is hope in this story. Even in dying there can be peace. There is also a lot of faith and love in this story. JH has a host of family around her to see her off. Undoubtedly, she had her God holding her hand too.
You fought a good fight JH. Rest in peace. It’s time for you to take it easy now.
Author Notes:
It is a very beautiful thing to have the privilege of watching a patient throughout their cancer journey and see them get to a place where they know their fight is over. As a medical oncologist, even though my job is to give people treatment for their cancer, a lot of satisfaction comes from seeing my patients self-declare they have reached their end.
I don’t often see my patients to the gate of death. Sometimes, I discharge them when they are still relatively well because we have run out of treatment options. Sometimes, they get too sick before running out of options and end up in hospice or in palliative care in the community or at home. These services are removed from my service of medical oncology. It’s rare for me to find out exactly how my patients die. The answer is almost always from cancer of course, but I’m talking about the human side of death – how did it happen, was there pain or was there comfort, did it occur alone or with friends present. I most often never know.
I appreciate JH’s sister calling to share with me the story of JH’s death. As I was listening to the way it unfolded, my mind drifted to the images of a sunset over an ocean – how life is like the sun each day, making a one-directional path through space and time with one goal: to set on the other side. As it nears the horizon, the distance travelled every few seconds seems to speed up dramatically. If one is lucky, one can witness brilliant oranges and yellows, dramatic pinks and reds, maybe even a hint of mauve. There might be a sliver of a cloud in front of the sun or an off-in-the-distance sailboat to make the scene even more pretty.
I hope the sunset JH saw was majestic. JH’s sun took its time to get to the horizon, but once it was near, she knew it was being engulfed by the other side quickly. Then, she let go. How beautiful is that?
I am curious to know, reader, what would your beautiful death look like? I know what mine would be.
