A Brother's Death, a Sister's Awakening

But the tumors eventually took over. "From then on, every scan identified new tumors, wrapping around his ribs, strangling his sciatic nerve, and penetrating the membrane around his brain," writes Kott, who lives in Sleepy Hollow, N.Y. "They grew inside his body and then pushed their way out. One engulfed his vocal cords, making it look like he'd swallowed a tennis ball."

But Steven continued teaching, hiding tumors under big sweaters and wearing a microphone headset "like Madonna" after the surgeon removed his vocal cords. Toward the end of his life, tumors forced him to walk bent at a 45-degree angle, leaning over a walker.

Near the end of her brother's struggle, Kott found herself wanting him to cling to life -- yet also wanting him to let go.

"It's such a delicate balance between life and death, between whose suffering matters," said Kott. "The bottom line is that it's the patient's suffering, not the people around the patient."

"It's very easy when death is an abstraction to make pronouncements," she continued. "When death is staring you in the face, you can't know, you don't know. Steven taught me that. He taught me that there's no knowing from one minute to the next."

More information

For more on end-of-life issues and cancer patients, visit the U.S. National Cancer Institute.

SOURCES: Andrea Kott, MPH, journalist and medical reporter, Sleepy Hollow, N.Y.; Michael Fisch, M.D., MPH, medical director, Community Clinical Oncology Program, the University of Texas, M.D. Anderson Cancer Center, Houston; April 11, 2007,Journal of the American Medical Association