The hope for a good death


When my active, cheerful, utterly practical seventy-five-year-old mom was diagnosed with advanced peritoneal/ovarian cancer two years ago, she was very clear on what she wanted to do to fight it: nothing.

No chemo. No radiation. No more surgery.

She had been hospitalized since the day of her diagnosis in late September, and was severely nauseous due to intestinal paralysis caused by an insidious coating of cancer. Barely able to keep down sips of water, she was tethered to an IV for total nutrition. A drainage tube ran from her abdomen, another from her stomach; a port had been inserted into her chest.

Throwing up became her penance for daring to drink (against doctor’s orders) a cup of water with ice, but she couldn’t resist the cold relief to her parched throat.

Mentally alert and completely cogent, she was unequivocal about what she was hoping for—a swift and painless death.

Her oncologist told her she could buy months, perhaps even a year, with aggressive chemotherapy but that the cancer would definitely return and, when it did, it would be aggressive as well.

Mom had filled out a living will years before, one of the generic kind you can purchase at an office supply store, and she told me to pin it on the front of her hospital gown. “That way they can’t miss it,” she joked.

The succession of doctors and nurses and aides and technicians who came through the door during her three-week hospital stay seemed baffled by her decision. Didn’t she want to eat real food again? Didn’t she want to see her grandchildren?

“Don’t give up!” they said brightly.

But mom knew, instinctively, that this was her final stand: she wanted to control the disease process before the disease controlled her.

Mostly to please everyone who couldn’t accept otherwise—me, dad, neighbors, and the entire medical staff at the hospital—mom endured one chemotherapy treatment, which ended up being a double-whammy given by doctors overzealous to prove that it could beat back the cancer and drive down her tumor marker count.

The result was two days of gut-wrenching agony. The oncology nurses were, again, puzzled. “We’ve never seen anyone have this violent of a reaction,” they said.

Mom knew, all along, the best course of action for her as a person and as a patient. The problem was, no one was listening.

As soon as she had regained her voice, Mom insisted on being transferred to a hospice, where the IV providing total parenteral nutrition was withdrawn and morphine and Ativan were given in controlled doses around the clock.

A nurse who believed in the laying on of hands came and placed her warm palms on mom’s stomach. I watched warily from across the room.

“What do you want to happen?” the nurse asked mom gently.

"I want to go quickly, with as little pain as possible,” my mother said firmly, staring unwaveringly back at her.

“Then I wish you Godspeed,” the nurse replied.

“Thank you,” mom said. “You’re the first person who has sounded like they meant that.”

Mom had a bath, a shampoo, some contraband Popsicles and Gatorade. She said her goodbyes.

A week later, she was sleeping almost all the time. She had begun, every hour or so, to move her arms up and down, up and down, over the metal bars of the bed in a graceful, fluid motion.

A friend who works for hospice said he had seen this repetitive movement before. “Their arms are the only part of their body they can move. Being contained in bed for days on end is hard.”

That, or it takes practice to fly away.

Two days later, mom died.

She never gave up hope. She was merely hoping for a death of her own choosing.



© 2007 Emory University