Going Gentle Into That Good Night

[Turkish Mickey]

you're in something of a unique position, having gone through such a tough experience. i am a 20 something who has never truly been sick, and for people like me i think microbob's comment makes a ton of sense. i have no idea what i'm going to think when i'm 90.

[MicroBob]

Look, I'm about to expand on something which I admittedly know extremely little about. So forgive me if a lot of this sounds incredibly juvenile or basic.
But my previous comment was called stupid so I now feel the overwhelming need to clarify my position somewhat.


donkey - Sorry for all you've had to go through. And I don't have the experience or background that you do of course.
But I stand by my comment. I just don't see how it's possible to know how you're going to feel at 90.
I, for one, have no idea how I'm going to feel at 90.
I might be completely comfortable with my impending death. I might be totally ready to move on.
I might be totally scared to death.
I could very likely be a combination of all those things I suspect.


In spite of all your surgeries, etc I'm not sure whether you got to the point where you really thought, "This is it. I'm going to die now. And I'm 100% perfectly okay with that."
Maybe you did, I don't know.

I've never been anywhere close to your kind of situation so I can't even imagine the kind of horrifying emotions people in such situations go through.


My grandma is 92. Has had a couple of surgeries the past couple of years. Obviously not much fun. In varying amount of pain day by day as is natural for someone so old.

She's also aware that she doesn't have much time left.
But she gets around on her own okay still. She still reads a ton and goes to church with her friends every Sunday.
Her brain is practically as sharp as it ever has been.

She certainly wouldn't want to go through pancreatic cancer. Nobody would. If the situation came to her I'm not sure she would want to go through any attempt to fight it off.

That does not mean she would go GLADLY onto the good night.
No matter how settled she might be that her end may be near I just don't know that she would be all that glad about it.


I had a friend who got cancer at 60 or so and decided not to have any chemo done on it. He knew this meant he had a year or less to live. He went off to Italy with his GF and tried to get the most out of his last days.
I completely respect his decision to not want to fight it.
But not fighting it and deciding not to put yourself through all the pain of a difficult, aggressive chemo-process doesn't necessarily mean you're completely comfortable with your fate or that you still don't have a feeling of, "this is happening sooner than I want. I'm not sure I'm ready to go."


Finally, my GF is a nurse at a hospital.
We don't talk much about her work because I think she doesn't want to dwell on it too much. But we do talk about it some.
Her experience is that different people approach impending death differently.


Knowing that you do not want to put yourself through total agony in a horrific situation or not wanting any heroic measures done to save your life is not necessarily the same as being comfortable with one's fate imo.


Do I know what I'm talking about? No.
I have absolutely no idea whether I will ever be able to say, "Okay, life has been good. I feel pretty ready to die now."

[Big Poppa Smurf]

[ QUOTE ]
[ QUOTE ]
I'll gladly go gentle into that good night.

[/ QUOTE ]


I just don't see how anybody can know they will feel this way at 90.

[/ QUOTE ]

because if I make it to 70 i'll feel lucky

[MicroBob]

I think I will also to be honest.
But I still don't know how 'ready' I'm going to be to move on.

I would love to think that when I'm in a ton of pain and on my death-bed that I'll be content with whatever is coming next.
But I just don't know that this is how it's going to be.

[TinderWall]

I think it's incredibly hard for someone to say, "Yup, I'm done," unless the circumstances are truly terrible. Maybe being a young guy has a lot to do with that, but I'm with Bob here, I think I'd fight as long as possible. I'm not at all comfortable with the thought of my own death.

[dizong]

[ QUOTE ]
[ QUOTE ]
What does Nana think about all this? Most older people I've talked to have a pretty realistic approach to death. We tend to want to keep them alive for ourselves regardless of whether they're ready to go or not.

[/ QUOTE ]

Nana is ready to go, but isn't going to up and quit. She will not consent to surgery or chemo, but if there are treatments that would maintain or improve her quality of life while extending it, she's all about that.

I agree with you that it's up to her. The idea I guess I'm objecting to is that we're all "supposed" to die at a certain point. Nana may not be contributing to the GDP, but I don't think that makes her life less valuable.

[/ QUOTE ]

If no surgery or chemo, then essentially she is destined to succumb to her cancer. Does not mean she is to be ignored... rather the focus on her care is different. Many people think that medicine is all about diagnosis and cure but it's a bit more complex, especially in the elderly and terminal. For someone like Nana, I think the idea of hospice care needs to be discussed. It's not a quarantine for the dying but it's changing gears for the patient (and those who care about her) from cure and prolonging life to comfort, dignity, and preparation for the inevitable. It's worth it because dying happens, and from your description, it sounds like she's headed there without question.

[4_2_it]

[ QUOTE ]
LFS,

Are you advocating Nana get traditional cancer treatments like chemo, surgery and radiation (potentially non-traditional ones, too), or are you just trying to get her some treatment for some of her symptoms (pain, etc.) on her way to passing? If it's the latter, I think this is how I would deal with the situation, and I support you. I also don't see why Cardo disagrees. If it's the former, it seems like the length of life added (if any, and you might even reduce it) is not worth the additional pain you add at this point.

[/ QUOTE ]

3 of my 4 grandparents went with the latter. Nana should be allowed to die with dignity and it sounds like that is what Slim wants as well. It's fine for a 90 year old to just get painkillers instead of chemo and surgeries that are likely to cause more harm than good.

My grandfather died of lung cancer. He lived a vigorous life and was active until the cancer hit him (he never smoked, but worked as a pipe fitter). He did not want surgeries or chemo, he just wanted to go home and see his family. It was tough to see him degenerate, but he met death on his terms which is something I hope I can do when it's my turn.

BTW, if Hospice is an option, I highly recommend it. The people they sent over were a great comfort to my family (especially my grandmother).

[MaxPower]

[ QUOTE ]
[ QUOTE ]
[ QUOTE ]
I'll gladly go gentle into that good night.

[/ QUOTE ]


I just don't see how anybody can know they will feel this way at 90.

[/ QUOTE ]

I almost felt this way at 30 with a lot of life ahead of me, so I think I'm qualified to say I will feel it at 90. I wasn't talking out of my ass. I have been there with the tubes sticking out of me,nauseous,in tremendous pain,having poisons injected into me to save my life. Hair falling out,avoiding the mirror because you don't even want to see yourself. Your family suffering almost as much as you because they have to watch. I had 8 surgeries before I was 32 and each one takes a little more out of you. The op said pancreatic cancer was the most likely culprit. Have you ever seen that up close and personal? I have and it's no picnic. Thankfully it's usually swift. I can say with certainty I wouldn't want to go through that at 90, and your stupid comment strikes me as most likely made by a 20something who has never been truly sick.

Edit-I just checked out your blog and see your definitely not a 20 something. Still a dumb comment.

[/ QUOTE ]

What Microbob said was not stupid, it was just his opinion. You also stated your opinion. Like it or not I agree with him and think you are fooling yourself. Compared to when you were 18, do you feel exactly the same way about things now? If you don't, then how can you say what you will want at 90.

And in case you are wondering, I am not a 20 something and very recently had a serious health problem. That shouldn't mater though and I don't know why you place such importance on it.

[cjmewett]

[ QUOTE ]
I agree with previous posters that often it's not the old patient who is fighting to extend every last minute of life. It's the (selfish and short-sighted, IMO) family members. This of course is not talking about palliative care, making someone comfortable as they die, or non-heroic measures that can actually lengthen life which still has a good quality. When I worked in a hospital as an intern I saw so many people on ventilators, old people who kept coming in and out of the hospital every month with a new pneumonia or heart problem or whatever, etc. It was unbelievable to me that their families would argue and push to keep these people going. For what? No wonder health care in the U.S. is so expensive. As Arfinn noted, in a socialist system (which I am not really advocating) this isn't a problem because it doesn't make financial sense to spend a ton of money on these really old people. It does them no good anyway, for the most part. It's not like after they get a little better and go back to their nursing home they are all of a sudden happy and leading rich, fulfilling lives. They mostly lay around waiting to get sick again.

[/ QUOTE ]
It's been noted once already on this thread, but I think the crux of the issue is that many of us (particularly Americans, I would think) don't enjoy the idea that someone else (especially the government) might determine what makes financial sense for an individual or what's "worth it." As for diverting funds from elder care to cancer treatment for an uninsured youngster, it's a nice warm and fuzzy thought, but it's inimical to the very foundations of a free society.

[Osprey]

It's easier to do everything humanly possible to keep someone alive than to make the call to end aggressive care. It's particularly rough on family to have to decide that we've done enough for Mom and Dad when they're old and sick in the hospital. This is particularly true for children who haven't been close to their family for a while and maybe haven't seen their parents for a while, I find that when the parents are dying there's often quite a bit of guilt which leads to doing everything possible. This also happens in gravely ill cancer patients who are almost certainly beyond the point of no return; no one wants to give up so you end up flogging a dead horse for weeks, sometimes months. In the case of the elderly, often the patient is too sick, or mentally disabled to make decisions on their own, and no discussion of what they would have wanted occurred when they were in better shape. There are many residents of nursing homes that are severely demented and go back and forth between hospitals and their facilities for months and years. They often have feeding tubes because they can't eat on their own anymore, and require total care.

I imagine the solution is probably the macro solution of the government of health plan. An enormous amount of money is spent in the last 6 months of life, and I doubt that that sort of outlay will continue to be possible as care gets more and more expensive and more and more becomes possible to do. If the decision is left in the hands of the family and medical practitiones with no consideration of cost, than the default will be to continue to fight. I know it will be very difficult for me when my parents become ill.