Tuesday, August 08, 2006

What do you say when a friend tells you she wants to die?

Let me clarify: this is an elderly woman, unmarried, with no children, who has metastasized cancer. This is not somebody lost in clinical depression, but somebody facing hard choices about quality of life and a bad prognosis.

My etiquette book has nothing helpful to say. When my mother-in-law used to tell me she was wishing she could die, I said the natural thing: Oh, not yet! Oh, not you! You'll feel better tomorrow. I think now that was maybe not the best thing to answer. It's hard to know what is right, though. Our culture does not deal well with death.

Very few of us have ever really attended somebody who was dying. Hardly anybody in the U.S. now dies at home or with family. We are carted off to hospitals where the whole focus is to stave off death at any cost. We have trouble making the choice to stop treatments and go for dignity and pain-free peace at the end. I don't know what to say to my friend. How hard.


Adrienne said...

I cared for my husband at home while he was dying of cancer. He came to that point where he had to make a hard choice about whether or not he wanted to continue treatment, and he finally chose not to so that he could be home and comfortable while he was dying. There is something in our society that wants to pressure us not to give up, but there comes a point, I think, where it's okay to say, you know, my time has come and what I can control now is the way I die. When Bri was making his decision, I'd talk with him about the pros and cons of getting more treatment vs. going into Hospice, and I just told him that I'd support him no matter what he chose.

I don't know if you or your friend know anything much about Hospice, but our experience with them was totally positive. They can support a dying person and their family/friends at home or in one of their facilities, and you can sign up for Hospice service as soon as you decide not to get any more treatment. For us, they had volunteers take care of getting all Bri's prescriptions, they had someone who came in and helped me with the housework and some basic care for Bri a few times a week, they got us a hospital-style bed. They did all sorts of things that allowed us to enjoy what time Bri had left. It was a gift I appreciate so often. I can't imagine what it would have been like to lose Bri suddenly from some side-effect from treatment in the hospital. We were both grateful to be home and surrounded by friends and family during those last couple months.

So, anyway, if your friend doesn't want any more treatment, I think it's okay to support her in that, to say things like that you don't want her to die but that you understand why she might choose to let this go. It's a hard thing.

Betsy McKenzie said...

Thank you, Adrienne! What a generous and helpful comment! Very thoughtful.

Anonymous said...

I worked as a social worker with the frail elderly for 5 years and dealt with this many times. This is a very very tough issue. I have to agree with Adrienne about considering linking with Hospice if the diagnosis is imminently terminal. There is no reason to be in physical pain in addition to all the other losses this person is undoubtedly facing.

Another issue most of us don't want to address is what we used to call "puttin' it in writing". Putting our wishes in writing while we are clear and have decision making capacity may feel a bit morbid, but if that unfortunate time comes when we may not be able to speak for ourselves, the right paperwork can make all the difference in terms of quality of life AND quality of death.

DNRs, Living Wills, and Health Care proxies are good starts. They may not be infallible (say you end up unconscious in a non-local hospital... the ER staff may not have your paperwork and will need to intervene), but they are sure better than nothing. There are various levels of detail a person may identify (say, pain management, removal of life support or feeding tube).

For example, my brother and I would like our mother to put her wishes in writing because we disagree on some things. Her doing this could spare a family dispute should the time ever come.

Also, when choosing a health care proxy, one should pick someone who'll carry out their wishes, regardless of how they themselves feel about it. This question should be asked before naming someone.

If your friend will give written permission, perhaps it's worth contacting her doctor to explain how she's feeling? A referral for counseling or medication might help, and perhaps she is just too down and dejected to do this for herself.

Sorry to be so verbose here, and I doubt I have given you any real comfort in this immediate situation. Things to think about.... but I do offer this: how blessed your friend is to have someone who cares so deeply at this time in her (and your) journey. I wish you both strength and comfort. You have my thoughts.

Adrienne said...

I agree with that comment entirely. We got all our stuff in writing when Bri was sick, including how we wanted funeral arrangements conducted and whatnot, and it was a HUGE comfort to discuss these issues and know exactly what Bri wanted when the time came and to have a piece of paper he created to point to when other family members got testy, which, of course, they're going to do -- even in the closest families. Death and grief are really stressful.

Betsy McKenzie said...

Thank you both for excellent advice! Your comments are very helpful, coming from true experience.