Last weekend I had fallen behind in my reading and wasn’t able to post discussion questions. I received feedback that readers preferred the questions. So I will try to do better in the future. I will now post questions for this week’s reading. Questions for next week will follow today’s critique.
~ How did you identify with Deb’s observations about nausea? What role did “Hope” play in your own treatment and recovery? In people with cancer that you have known, did attitude seem to mke a difference in how they were coping? What role did spirituality play during your illness? What about Deb’s concept of control, especially in how she would deal with her last days? What did you think of Deb’s hints at eventually taking her own life?
By now we are more familiar with the main characters in this account, their personalities, proclivities, professional lives. And yet we see, with some satisfaction, that each is still growing. Deb is constantly adapting to new challenges of her waning, then surging symptoms. Dr. Lois continues to learn about herself, her relationships, and how she wants to evolve as a healer.
One thing that struck me was Deb’s simple description of the experience of nausea. Many of us can relate to this. “Nausea is centered in the tummy, but it changes the way you see and the way you walk, if you are walking at all.” Dr. Lois discovers the importance of hope for her patients. “Hope makes it possible to undergo the pain of surgery and the side effects of chemotherapy. Hope makes a believer of both the patient and the doctor, makes them think that this is the rare patient that will survive.”
One of the questions I posted for this week was if any of you have perceived that the attitude of the patient made a difference. I mean a difference if how effectively one copes with cancer and its treatment. To talk about differences in outcomes is very slippery slope in which one becomes responsible for one’s outcomes. Most of the time and in most respects the cancer’s outcome is beyond our control. But Dr. Lois notes, admittedly with scientific evidence, that “the patients who can still laugh out loud seem to fare better than those who lose their joie de vivre.”
Dr. Lois gives an excellent account of the particular horror of ovarian cancer treatment, especially recurrent disease. “The administration of toxins is now going to be a lifelong process.” The oncologists has an array of “second-choice” drugs in her bag but has no way of determining which, if any, of these is going to be effective slowing the progress of the disease. This is not treatment for three weeks then off three weeks for a given number of cycles. This is constant and continual therapy.
Quality of life becomes the constant, moving target in the tension between the costs and benefits of treatment. This is so much the case that Deb begins to hint at suicide, suggesting that she plans to keep “a stash of drugs squirreled away in the house.” The doctor senses in this at least the fear of tremendous pain and promises that pain will be managed. In my twenty years of experience, I am happy to say that I think we were nearly always able to control the pain of end-stage patients. As the doctor points out though “anxiety, fear, and spiritual distress…can produce tremendous physical pain.” Most oncologists recognize this and include anti-anxiety and anti-depressant agents when needed.
There is a discussion about intensity and living for the terminal patient. “If a woman is dying at forty, she has to cram the rest of her natural life – the life that was taken from her – into the little time that’s left….It doesn’t get much more intense.” Dr. Lois notices that this intensity fosters the growth of a spiritual dimension to relationships, including doctor-patient relationships. It is this spirituality that is the theme of this unique cancer memoir.
It is another valuable revelation Deb imparts to her doctor when she states that she intends to forgo any life-prolonging measures such as tube feeding. “I am not going to be medicalized… I want at least some control over my body.” As her kidneys start to fail, Deb consents to having internal tubes or stents placed, an intervention that is only partly successful. Deb becomes disoriented and confused until a second attempts achieves better results. This is only illustrative of how difficult specific end-of-life decisions can become. This also underscores the importance of making advanced directives as I wrote about in the previous post.
Reading Assignment: finish the book, starting with “The Interview” and ending with the two appendices.
Discussion Questions: Deb’s daughter, Abby, rather bravely interviews her mother for a sociology of death paper. What did you think both about the courage of that process and about some of the observations that Abby makes? Respond to the quote “I am younger for (Dr. Lois’s) friendship and with her I have plans that involve both desire and good work, the imaginary and the real.” What was your reaction to Deb’s thoughts about the probability of her husband remarrying after her death? What are some of your reactions to the book’s treatment of Deb’s last days?