Wednesday 23 October 2019 ,
Wednesday 23 October 2019 ,
Latest News
  • It's a responsibility for all to ensure road safety: PM
  • One-minute digital account service kicks off
  • Bhola SP’s Facebook ID hacked
  • Govts, Internet companies fail to meet challenges of online hate: UN expert
  • National Road Safety Day today
24 June, 2019 00:00 00 AM

Let's talk about the art of living and dying well

The Guardian
Let's talk about the art of living and dying well

It isn’t until my patient dies that I calculate we have known each other for 10 years, the time it took for her recurrent cancer to extinguish her life. I use the word “extinguish” deliberately, for her two young children should have had her for longer. Her devoted husband sends me a peaceful photo of her from the hospice and details of her funeral. I choke – and tell myself that I have a full clinic of patients.

Sometime later, I call him.

“I am sorry she’s gone. How are you?”

“To be honest, relieved.” His voice sounds definite and strong.

The response takes me completely by surprise, evoking a curious mix of admiration and resistance. I think I was expecting to hear he is devastated; that after a thousand appointments, his days have fallen quiet; that he can’t get over questions about the randomness of life. I know him well enough to ask about the children. I never met them but they were always part of my equation of keeping her well for as long as possible.

“They’re back at school, doing OK. They’ve expected this for a long time.”

In that moment, I know that they’ll be all right. As her health alarmingly deteriorated, I’d worried about its ultimate effect on him. What happened to survivors consumed by a loved one’s illness? What moved in to fill the void? In this instance, a deep sense of peace and closure.

Though her death was inevitable, many of us had shed tears. After a decade of shared lives, I realise this is our final conversation, and now I want to relay our sorrow without somehow diminishing his sense of relief.

“I want you to know how much we admired her strength and your devotion to her. You did everything you could.”

My voice cracks. He thanks me softly and we hang up.

 

We would all do well to occasionally pause and reflect on the things that really matter

The next minute I am hurrying up the stairs to rescue my perturbed resident from an irate patient. He’s in his 80s and the situation is best summed up by the resident. “He can’t believe he is dying and his family isn’t helping, either.”

I reach the bedside of the angry patient and disbelieving relatives seeking to re-prosecute the case of his progressive cancer and my “failure” to find a viable treatment.

I draw pictures, share results and patiently explain how further chemotherapy is dangerous and why it’s inappropriate, even unethical, to enrol him in a clinical trial in his bed-bound condition. But I can also see my words falling on deaf ears, which means that the end-of-life care he needs isn’t going to eventuate.

Desperately, I ask: “What would you like me to do?”

“To make me better, obviously.”

The palliative care nurse sighs. I am reminded of a saying from the Mahabharata, a 3,000-year-old Indian epic.

“What is the most surprising thing in the world?” a celestial figure asks a nobleman.

The nobleman replies: “Day after day man sees countless people die but still he acts and thinks as if he will live forever.”

Being an oncologist is to have a window into how people from different walks of life contemplate their mortality. But in a society that struggles to view any death as “good”, it is also an unmistakeable opportunity to share what at least constitutes a better death.

Acceptance is foremost. Some of my most remarkable patients have accepted early that they have not been singled out by misfortune, that suffering in different shapes is the course of humanity. I once told a terminally ill patient how much I regretted her predicament. “But we all die.

My time came a bit earlier and it’s nobody’s fault,” she replied with an equanimity that became the hallmark of her short life. She showed me how this vital understanding insulates us from excessive bitterness and rage while leaving open the possibility of doing everything we can to remain well and live a life of meaning.

The elements of a meaningful life may sound like a topic fit for armchair philosophers rather than the majority of us who have a hard enough time fitting in work, bills and caregiving duties. But I routinely see how “ordinary” people create meaning by deliberately practising forgiveness, kindness and generosity.

I’ve often thought that the chemotherapy unit is one of the kindest places in the hospital. Here, patients find the energy to bring lovingly baked scones and handmade cards to say thanks and give encouragement even though we all know the system periodically fails them.

Others bear with delayed procedures, unexpectedly generous and genuine in their concern for patients who are even sicker. Among their own substantial worries, I am always touched by how many patients ask after my children or care for my wellbeing. These simple and inexpensive gestures leave a legacy of goodwill for takers but they also enrich the giver.

Modern life is governed by an individualistic philosophy but, when it comes to dying well, the role of family and friends is crucial. Illness and with it the decline of our former proud and independent selves can be ably tempered by loved ones who value us outside of our visible success and career accomplishments.

When we feel diminished, they are best placed to reassure us that we are more than a title or a salary. No one can replace the family as the most potent reminder to the dying that their memory will be safe and cherished and that it’s OK to let go. I see many people wanting to help their loved one achieve a better death but not knowing how.

Those who succeed say that a key step is self-awareness. A reluctance to contemplate one’s own mortality makes it doubly hard to accompany others on the journey, and we would all do well to occasionally pause and reflect on the things that really matter.

Part of my job is to encounter surviving relatives in all kinds of places – at the pool, while buying groceries and in the clinic, when another family member is diagnosed with cancer.

When I was younger, I used to wonder how anyone ever got over loss but the older I get the more I discover the infinite capacity of the human spirit to rise again. Survivors grieve in all kinds of ways. One family brings a monthly picnic to grandpa’s grave, another scatters the ashes in the Ganges or the Atlantic, and another will need a lot more time.

But I am consoled to find that reconciling to a death is possible without diminishing a person’s significance, something even the most heartbroken of us would do well to remember.

No individual could possibly have all the wisdom needed to live well and die peacefully but being an oncologist is to be granted access to the collective wisdom of patients. Many of my patients told their story because they wanted others to learn. They knew that they were dying but they would be thrilled if their lives provided a meaningful template for the rest of us trying to make sense of life and death.

Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death

 

Comments

Most Viewed
Digital Edition
More story
Editor Speaks

Editor Speaks

Osteoporosis is commonest metabolic bone disease, occurs in old age and different from osteomalacia - rickets. There is progressive decrease in the density…
Osteoporosis

Osteoporosis

Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis literally…
WHO criteria for diagnosis of osteoporosis

WHO criteria for diagnosis of osteoporosis

Under the auspices of the World Health Organization (WHO), a panel of experts has periodically met on the topic of assessment of fracture risk and osteoporosis.…
Osteoporosis: An epidemic with dire consequences

Osteoporosis: An epidemic with dire consequences

Osteoporosis, which literally means porous bone, is reduced bone mass per unit volume thus predisposing the person with it to an increased risk of fracture.…
An overview of juvenile osteoporosis

An overview of juvenile osteoporosis

LANA BARHUM Osteoporosis a progressive bone disease where bone density is lost or there is insufficient bone formation. The result is weakened bones and…
How to cope with some of the most difficult menopause symptoms

How to cope with some of the most difficult menopause symptoms

 ALICE OGLETHORPE Menopause happens to every single woman, but that doesn’t mean the symptoms—or best treatments—are the same for…
Melanoma stages: Prognosis, survival rates and treatment

Melanoma stages: Prognosis, survival rates and treatment

LISA ESPOSITO Melanoma is one of the most serious forms of skin cancer. In early stages, it may be treated through relatively simple surgery, but advanced…
When to be concerned about constant ringing in your ears

When to be concerned about constant ringing in your ears

 BETH KRIETSCH Have you ever experienced ringing, buzzing, hissing or other noises that no one else around you seems to hear — and you wonder…
The health benefits of cinnamon essential oil

The health benefits of cinnamon essential oil

CATHY WONG Cinnamon essential oil is a type of essential oil used in aromatherapy. The oil has a warm, sweet aroma, and is sourced from the bark of the…
5th International Medical Mission 2019 held in Dhaka

5th International Medical Mission 2019 held in Dhaka

Week-long 5th International Medical Mission held in Dhaka from 12-17 October 2019 organized by Rotary Club of Dhaka Mavericks with the collaboration of…
Microphone could diagnose 'noisy' arthritic knees

Microphone could diagnose 'noisy' arthritic knees

Technology used by engineers to listen for faults in bridges could be used to diagnose 'noisy' arthritic knees, a study suggests. It involved…
1st Scientific Congress on Non-communicable Diseases held in Dhaka

1st Scientific Congress on Non-communicable Diseases held in Dhaka

The Clinical Research Platform, Bangladesh, a tripartite initiative of icddr,b, Bangabandhu Sheikh Mujib Medical University (BSMMU) and the British Medical…
Lilly's REYVOW™ (lasmiditan), the first and only medicine in a new class of acute treatment for migraine, receives FDA approval

Lilly's REYVOW™ (lasmiditan), the first and only medicine in a new class of acute treatment for migraine, receives FDA approval

Eli Lilly and Company (LLY) announced recently that the U.S. Food and Drug Administration (FDA) has approved REYVOW™ (lasmiditan) an oral medication…

Copyright © All right reserved.

Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Disclaimer & Privacy Policy
....................................................
About Us
....................................................
Contact Us
....................................................
Advertisement
....................................................
Subscription

Powered by : Frog Hosting