"I understand," the doctor told me "I have an 86-year-old mother who hates doctors. It's quite embarrassing."
The doctor was taking over the management of my nearly 80-year-old mother's case of terminal cancer. A kindly man, who understood this was not the time for treatment but for palliation and the patient's comfort, he was a godsend to a woman who had long since selected to do without the services of orthodox medicine.
What Mother had been encountering were high-tech physicians who couldn't accent someone who had decided not to leave the world via the Hubert Humphrey route. Ten or 12 years ago when she first became aware of having the disease, mother had decided she would not permit surgery, radiation or chemotherapy, and she has stuck to the decision ever since.
It was up to the rest of us to convince the various kinds of practitioners of medicine that she was of sound mind and mature judgment and her wishes should be observed. That's not so easy with some kinds of doctors. In certain situations it's not the family that pleads for something, anything to be done, but the doctor who pleads with the family to permit it.
A little reading and a little asking around should quickly convince anyone that a patient with advanced cancer may be making a medically sound choice in refusing treatment. Often the odds that the treatment can have even a temporarily palliative effect are long, while the odds that the same treatment will cause awful side effects are relatively short. You won't bet money on a race horse with those chances so why bet the last days of your life?
For some doctors that's hard to live with, so hard their own emotions push them to say wild things in order to be allowed to get at the patient. "You may have heard a lot of romantic things said about a dignified, natural death," said one, "but I'm telling you there is no such thing." Or there was the physician who came into Mother's hospital room to argue her into accepting treatment at 11 o'clock at night. When the patient, paralyzed in her bed, said she was tired and wanted to sleep, the doctor responded, "You know sleep is sometimes a form of escape."
Some weeks ago Mother decided she would prefer to pop off, as she often refers to her death, via a pill. Four or five times she's brought up the subject of suicide by pill, but in our culture children usually can't bring themselves to give their parents the means to do that.
You have to get your pill for yourself, when you're still healthy. Only rarely will a loved one have the moral self-confidence, the ethical certainty to help you.
Maybe none of us would contemplate taking our own lives if there were institutions for dying. My mother has loved the hospital, but the hospital couldn't keep her. In her advanced state of illness - she is so feeble she can't turn over on her side without assistance - a hospital with a high standard of nursing care can make her reasonably comfortable.
But hospitals aren't places designed to make dying people comfortable. They are treatment institutions. Moreover, under pressure from every side to cut costs, hospitals feel a special obligation to toss out Medicare patients like my mother who will not take any medicine. "Will you let me stay if I take an aspirin," asked Mother, her sharp tongue undiminished by age and illness. Actually, if the family can afford $250 plus a day, the guest may continue to abide on the premises.
Four patients like Mother, the solution may be the hospice, a new kind of institution expressly designed for the dying. These are low-tech places where the physician and spiritual comfort of the patient comes first. Whether we can find enough of the right kind of people to work in hospices is problematic. So many of us have been trained to believe the only people worthwhile are those who can perform the miracles of science; we accord little prestige to those who work the less brassy miracles of comfort compassion and the charity that surpasses understanding.
"I feel like a ball being bounced from one place to another," Mother said of the vicissitudes of finding a peaceful and moderately comfortable, Medicare-approved place to die. She is a woman who has composed her soul, she has made her peace with all of us who love her and is leaving us with her blessing, but meekness and forgiveness can be carried too far. "I want you to promise me," she said the other day, "that after I pop off, you'll make sure my body isn't given to medicine."
Mother died on April 28, and it wasn't.