I have always been afraid of lung cancer. A former smoker, I know it is a very real possibility. So I was stunned when a healthier (than me) friend received a diagnosis of non-small cell lung cancer with metastasis to the brain. Chilled to the bone is more like it. My vibrant, life-loving pal, who had inspired me on so many levels, was now almost certainly facing the end of her remarkable life. Four months later, she was gone.
In the months since her death, I have made several realizations I’d like to share with you. Let me just mention that I am a cancer survivor myself, so I speak with some awareness of what it is like to endure a life-threatening disease.
1. Don’t be jaded about changes to your health. In the relatively brief time I knew my friend before her diagnosis, she had mentioned on numerous occasions not feeling completely well. She had difficulty sleeping. She felt nauseous sometimes for no reason. Her appetite wasn’t what it used to be. She had a dry, nagging cough. But she also had a high-deductible health insurance policy and hated to spend money unnecessarily, so she put off consulting a doctor until things got very bad—and by then it was too late. What I learned: Keep your priorities in perspective. Good health should be at the top of your list. Money is only money, but your good health is the key to life itself.
2. Get second (and third) opinions at the time of diagnosis. It was very late in the course of her cancer that my friend was diagnosed, and unlikely that she could expect to survive over the long term. Although she did drive several states away to consult a major cancer center, where I am not sure what she was told, she returned home and settled for cancer care that seemed, to my eye, somewhat erratic and unconsidered. For example, the brain metastasis was surgically removed first (as it probably should have been), but her oncologists failed to convey to her the importance of a speedy recovery to ensure timely treatment of the malignancy in her lung. So valuable time was wasted that could have prolonged her survival or enhanced her quality of life. What I learned: Get a cancer team, not just an oncologist. Make sure your treatment is well coordinated between all the specialists involved, and also require your doctors to explain things to you in a way you can understand—and to include you in the decision-making.
3. Enter hospice care sooner rather than later. Because she didn’t want to feel that the end was imminent, my friend put off hospice care as long as possible, leaving her caregivers frazzled and, as a result, not as effective or supportive as they might have been. Many hospice care programs require a doctor to certify that the patient has less than 6 months of survival ahead of her. My friend didn’t enter hospice until she had less than 2 weeks left. What I believe: She would have been more comfortable, and happier, and less traumatized, if she had asked for hospice care much sooner.
4. A calm environment is vital. Near the end of her life, when I arrived to sit with her in the hospital, my friend commented that my presence provided a calming effect, and she said it meant a lot to her. I tended to let her sleep when she was tired, and to divert her attention when she seemed anxious or upset. After she lost the ability to articulate her feelings, and her breathing grew labored, I read aloud to her in a low voice for several hours, until her breaths began to even out and come easier. And I noticed that, when the person scheduled to relieve me arrived, the noise level increased by about 50%, and the awareness of my friend’s fragility seemed to decline almost as much. No surprise, then, that she began to appear to be in some physical distress until I managed to quiet the new arrival down to some extent (and request a tranquilizing agent for my friend). What I learned: The dying are much more sensitive to their environment than they at first appear, and lack the resilience (to loud noises, jarring movements, etc) they once had. So it’s important to pay attention to subtle clues to their true state and to keep things calm.
5. Human connection is critical, even when someone is unresponsive. I made it a point to touch my friend regularly, and to talk to her about what was going on in the larger world. I would rub her (bald) head gently, or paint her toenails, or read or talk softly to her. She could no longer sit up or speak and rarely opened her eyes. But I remain convinced that she could feel and hear me and, at least on some level, understood what I was saying. This is where the golden rule comes into play: Do unto others as you would have them do unto you. I would not want my family and friends to treat my unresponsive body as an object rather than a human creature, so I made continuous efforts to communicate.
My friend has been gone for more than a year. As time passes, one regret I don’t have is the way our friendship ended. I regret her illness, the physical loss of her, and the suffering I know she endured. I also regret not taking her physical complaints more seriously in the weeks leading up to her diagnosis. But I feel satisfied that I was there for her in her dying to the fullest extent I could be. And that is no small thing.
End cancer now 