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I have metastatic breast cancer (stage 4) with which I was diagnosed 2 years ago. I actually participated in the series “Repossessing Virtue” in April 2009 from the perspective not of an economic crisis but of a health crisis. Many of the issues are the same.
I read the article by Dr. Gawande with some dismay – that seemingly so many medical professionals are unaware of end of life issues that have nothing to do with curing the body. At this point in our medical knowledge of metastatic cancer, it can not be cured. And treatment can be as deadly as the disease for some people. Patients who are able to hear and receive this information (or who can be helped to do this) are given the possibility of real transformation and healing in their lives. For reasons I mentioned in the earlier article, I was able to hear and receive such information.
My oncologist at Massey Cancer Center in Richmond, VA, as well as the doctor at Sloan Kettering in NY from whom I sought additional advice, were honest but compassionate. When I was diagnosed as stage 4 with a metastasis to the liver in a spot very difficult to treat except through chemotherapy, she looked at me kindly and said with honesty something like, “The average life expectancy of someone in your position is 18-24 months”, quickly adding that because I could take a specially targeted drug Herceptin, I certainly had a longer time frame possible. We would find out in time. She advised me to get my affairs in order. I was fortunate in that my financial affairs were in order as well as my emotional and spiritual states. They were stable and strongly grounded. At Sloan Kettering, it was reiterated that there was not a cure for my cancer, though possibly other options to chemotherapy, and that palliative care was all that was available at this time. I could hope for some good quality of life if my treatment progressed well and the disease could be kept at bay without too much toxicity to my body. The term used now is NED, or no evidence of disease . At which time I said that quality of life was more important to me than quantity and that I would not be receiving chemo on my death bed. They nodded understandingly.
Cancer or any illness can be one of life’s great Teachers. It can be a blessing. As another cancer patient wisely remarked, we are the lucky ones. We have compelling reason to think about many deeply personal and spiritual issues and share them with those we love. We have time to heal, to love, to forgive, to ask forgiveness and be forgiven, to grieve lost relationships and dreams, to say goodbye and to prepare for the next journey in our existence when our physical body no longer exists. There are many who can help us do this if it seems difficult. This is part of what hospice can do beyond physical care and pain management necessary for a more graceful end to life.
Fortunately my treatment has progressed well, and I still have some quality time left. Though there is evidence of disease now after 18 months without it and I am under going treatment again, there is life to live and joys and sorrows to be experienced. It is not the time for me to discontinue aggressive treatment and enter hospice. I am grateful for the health care professionals who have allowed me to live more honestly and consciously.