"A long memory can drive a man crazy."
-- Brit Bennett, The Vanishing Half

Thursday, March 8, 2012

Death Be Not Proud

     Last weekend, on the train ride home from New York City, B and I spent a good hour talking about end-of-life issues.

     We'd gone to New York to see Wit, starring Cynthia Nixon, about a woman dying of cancer. You may have heard of it, since the play, written by Margaret Edson, was originally produced off-Broadway in the late 1990s and won the Pulitzer prize for drama in 1999. Then in 2001 HBO produced a TV movie of the play starring Emma Thompson.

Cynthia Nixon as Dr. Vivian Bearing
    I'm not a true Cynthia Nixon fan. I saw a few episodes of "Sex and the City" and I've seen her in "The Big C" -- but I'm mesmerized by Laura Linney, not Cynthia Nixon.

     Nevertheless, Nixon does an amazing job as Vivian Bearing, a woman with a PhD in English who specializes in John Donne (1572-1631), the poet famous for his lines: "Death, be not proud ..." The play chronicles Dr. Bearing's story, from a diagnosis of stage IV ovarian cancer ("there is no stage five") to her death. She embarks on her journey with no friends and no family, just her uncompromising academic standards. Along the way she meets her match in an equally impersonal and disinterested medical student, and in the end only finds some measure of solace in an unlikely companion.

     The final moment of the play presents the audience with a brief nude scene, as Cynthia Nixon completely disrobes. But by that time, she has exposed such raw emotions, with such complete abandon, that the idea of nudity seems almost ... anticlimactic.

    After the play was over, it was impossible not to discuss some of those end-of-life issues, including the "Do Not Resuscitate" option, and that's what B and I were talking about on the way home. B is all in favor of the DNR order and other health directives aimed at dying with dignity. She also has long-term-care insurance, a power of attorney, and some other health documents as well.

     I'm not quite so organized. Nor am I quite so ready to look death square in the eye. Perhaps it's because B is more religious than I am, and a little more comfortable with the notion of death. I guess I would opt for a DNR order, if I really and truly knew I only had a few days to live, and I was in excruciating pain, and I knew there was no hope at all of recovery. In other words, I'll sign those papers when I get to be 90.

     Coincidentally, author Ken Murray, a retired doctor, wrote an article appearing in The Wall Street Journal, "Why Doctors Die Differently." He reported that many doctors, who know all about the treatment options and have access to top medical care, often decide against undergoing cutting-edge medical procedures. They accept death, and instead go home to live out their lives as best they can and spend their last days with their loved ones.

     "It's not something we like to talk about, but doctors die too," writes Dr. Murray. "What's unusual about them is not how much treatment they get compared with most Americans, but how little."

     He cites the case of an orthopedist who found out he had pancreatic cancer. Instead of opting for aggressive treatment that would give him, at best, a 15% chance of surviving, with a poor quality of life, he focused on spending time with his family. And Murray cites the case of his own cousin, diagnosed with lung cancer. The cousin decided against radiation or chemotherapy, and instead spent the next eight months going to Disneyland and hanging out at home watching his favorite sports teams -- then dying peacefully in his sleep.

     I remember by own dad, who died ten years ago at the age of 91. He'd developed shingles, and when he didn't get better the doctors found he had cancer in his bones, his lungs and everywhere else as well. The doctors were ready to give up on him -- after all, he was 90. But he wasn't ready to go. He wanted treatment. We got him to the hospital where he received some radiation therapy. No one ever said it would be a cure. But it did arrest the tumors for a while, and gave my dad an extra couple of months of relatively pain-free life -- which we all appreciated, my dad most of all.

     There's no easy way to get out of this world. And if you think there is, go see Wit. The play will cure you of any illusions you have on that score. But I'm sure it would help if you have some control over the process, if there's a way to make death less painful and desperate.

     I should go make out some health directives ... I really should.

     So ... here's the John Donne sonnet which features prominently in Wit:

Death, be not proud

by John Donne

Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think'st thou dost overthrow
Die not, poor Death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul's delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell'st thou then?
One short sleep past, we wake eternally
And death shall be no more; Death, thou shalt die.


Kay Dennison said...

That's one of my favorite poems.

I've had Last Rites three times -- so far -- and the Big Guy keeps throwing me back. I keep saying that God doesn't want me and Satan's afraid I'll take over. I just can't worry about it.

Janette said...

This is one of the most important posts I have read in a long time. I too have noticed that doctors past 65 do not fight cancer. I have also witnessed family members emotionally forcing elderly to take" just one more treatment. "
My uncle just died of cancer. He was 86 and took no therapy. I was so proud that he accepted that you have to die of something.
You might consider cutting this post in two and reporting them as sister entries on the same day...

Dr. Kathy McCoy said...

This is an excellent, very important post, Tom. I think all of us struggle with the notion of end-of-life: the reality and the issues surrounding it.

All of my older generation relatives have died and all of sudden cardiac death. That generally seems a good way to go except for the absence of goodbyes. However, I have warm memories of my last conversations with all concerned and like remembering them that way. I hope my departure will be the same, but at a later age than my parents, who died at 66.

It makes sense to have health care directives, power of attorney, a will or trust and something written that lets your loved ones know your wishes regarding funeral, burial or cremation. One way of looking at it all is that you will have a brief time of discomfort thinking about it all and then once you have everything in place, you can forget about it.

stephen Hayes said...

I can't add much except to say that I was moved deeply by your post and will be thinking about it for the rest of the day. My mother is eighty-six and in very good health but she refuses to deal with the future, refuses a power of attorney or any document stating what she wants to happen when she passes. When asked she says, "You know what I want. Just tell them." Of course the doctors won't do what I tell them without legal authorization, but so far I haven't been able to convince Mom.

schmidleysscribblins,wordpress.com said...

I love John Donne, and loved Emma in Wit. No fan of Cynthia's either. The last line of the play, "Angels sing you to your rest from Hamlet," broke me up.

Death is a heavy topic. We have directives and I have purchased niches for cremated remains. Leaving nothing to the kids.


Rubye Jack said...

I saw the film. It had a profound effect on me and changed the way I look at the way I want to die. I think it should be required viewing for everyone.

I did an Advanced Directive and DNR awhile back and I am not religious-at all. You can always reverse them. I just don't want to live my last days in agony. People get upset with you when you don't want treatment and talk about how one should cling to life because it is so precious and on and on...
It would be nice if we would learn to better respect other people's decisions with regard to death and dying. We all will die someday. We can either accept its inevitability or die fighting. Neither choice is wrong.

Thanks for this post June!!!

Olga said...

I have my DNR and Advanced Directive in order. I have read about how doctors die before...tells me something. It's kind of like they honor the old days. After my sister-in-law was diagnosed with amyloidosis, she went about the practical business of dying and putting affairs in order. She would cheerfully say, "It's not painful!"

Arkansas Patti said...

Sometimes having a time frame helps one to make those difficult decisions.
I have no fear of death but do have a fear of being tortured my last days.
I probably need to get a DNR tatoo on my chest just in case I get separated from my papers.

Dick Klade said...

We've done all the documents, and that in itself gives us peace of mind. I'm ready to go, but I'm not in a hurry.

Knatolee said...

I remember when that play came out I wish I could see it!

Being married to a lawyer, we have our wills and power of attorneys all in order. My parents died at 61 and 64, so I like to be prepared. I sure hope I live longer than they did, but you never know! But I think a lot of people are uncomfortable thinking about this stuff. My hubby knows what I want, and so does my friend (in case hubby and I are simultaneously incapacitated!)

I read an interesting article on this sort of subject yesterday:

Catch Her in the Wry said...

These choices are very personal - there's no right or wrong.

My brother died of pancreatic cancer at age 51 and did everything he could to stay alive as long as possible because he had 3 children under the age of 17. He went through a great deal of pain to remain alive an extra 15 months.

I would not have done the same thing, but my children are grown and on their own so there are different circumtances.

I'm not religious, but I have DNR, healthcare POA and will/trust done just because it makes good sense financially and for easing decisions that my family may need to confront.

Friko said...

It's DNR for me and, if only I can find a good physician, a little help towards the end as well.

We have palliative care now and nobody should die in agony, yet still, the kind of death some people have shouldn't happen to an animal. Oh stop, it doesn't, we put them down humanely.

Anonymous said...

Two things struck me about that Murray article: (1)the stunning arrogance of the writer ("It's not something that we like to talk about, but doctors die, too."). News flash, buddy. Nobody likes to talk about dying and you're just like the rest of us. Spare me. And (2) just who do you think has promulgated this myth on the American public that you can beat death over and over? Why DOCTORS, of course!