Viewpoints

When does a longer life become not worth living?

Ronald C. Chen consults with colleague Misty Lehman-Davis on a patient’s scans at the UNC Lineberger Comprehensive Cancer Center in 2016. Chen is the lead author on a new study of aggressive cancer treatment in the last month of a patient’s life.
Ronald C. Chen consults with colleague Misty Lehman-Davis on a patient’s scans at the UNC Lineberger Comprehensive Cancer Center in 2016. Chen is the lead author on a new study of aggressive cancer treatment in the last month of a patient’s life. Associated Press

In book club, we women of a certain age sat around and talked about death. Not because that was the topic of our book, but because a member of the group had lost her husband to lung cancer just a few days earlier.

She came to club anyway and told us their story. Her husband – I’ll call him Ben – had been a heavy smoker, but had quit decades ago. They had retired early from their jobs at the same newspaper, volunteered in political campaigns, cooked gourmet meals together and bought a small camper truck to travel extensively. Their forays across North America lasted weeks or even months and though the RV life is a cliché of retirement, their Facebook photos were so breathtaking, so intriguing, I followed them like a virtual groupie.

A couple of months ago, though, Ben was hospitalized with a particularly stubborn case of pneumonia, and doctors found a growth in his lung that was keeping fluid in the lower portion, providing breeding grounds for recurrence.

It was malignant, and the cancerous cells had crept into his lymph nodes. Surgery would be futile, but chemo stood a good chance of lengthening his life. Ben was all journalist in his unflinching questions. How much time? Months or years? How bad would the chemo be? The answers, ultimately, were: “we don’t know,” “not terribly long” and “very bad.”

Ben said no. He had taken full advantage of his time since retiring a decade ago. He’d traveled like never before, built houses for Habitat for Humanity, lived with gusto. What would a couple of sickly extra years bring him that was better?

He soon developed pneumonia again. Hospice workers made him comfortable and he died a few days later in his home.

Give up on extra time? Isn’t that exactly what it sounds like, giving up? But we all agreed: This was what we would want, too. Not the drawn-out, painful decline in nursing homes that some of our parents had suffered. No extreme measures to keep us barely alive. No last-ditch killer chemo that would have no realistic chance of restoring us to meaningful life.

No one was against treatment for life-threatening diseases. One woman’s husband has had several cancer-free years after surgery and chemo for esophageal cancer. Another woman is undergoing chemo herself, for breast cancer that was fortunately found early. And some people might have a special goal that makes any lengthening of their life worthwhile – a wedding or a grandchild about to be born.

But the women in my book group had seen not just the good that aggressive medical treatment can do, but also the pained, desperate lunge for a little more time, even though the chances are remote and the treatment worse than the disease.

Studies released a few years ago that found many terminally ill patients don’t fully understand their situation. Unlike Ben, they don’t want or don’t know how to ask the tough questions, and their doctors are uncomfortable giving them the tough answers. Cancer patients who were receiving end-of- life chemotherapy often died within weeks in the ICU, one study found. The treatment never had a chance of curing them or even extending their lives; it mainly made them miserable in their last days and weeks.

Life is all we have. We don’t want to let go and our loved ones don’t want us to leave them. But it’s time for more of us to re-evaluate what a long life means. Is it measured by years, or by meaningful moments, lived fully?

Karin Klein is a freelance journalist in Orange County who has covered education, science and food policy. She can be contacted at karinkleinmedia@gmail.com. Follow her on Twitter @kklein100.

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