Sunday, June 10, 2007

Fight or Surrender?

I see it in so many ways and so many situations around me. The “fight” for survival. When I watch my friend who is in failing health sign up for an invasive experimental surgery, I ask myself if I would put myself through that or if I would simply call it a day? When I see owners drag very sick pets in to our veterinary office time and time again, I wonder what my limits will be for treating my dog when she gets to the end of her life. There is no right answer, only the question.

Example 1:

When you work in a veterinary hospital, death comes wrapped in a unique package. With the possibility of euthanasia, end of life issues are complicated by the opportunity of choice. Owners and doctors collaborate on when they believe the animal has “had enough” and often opt to put them to sleep. Within this opportunity of choice lies a spectrum. On one side you will find the owners who request euthanasia when a pet is not even sick but is “annoying” or “aggressive”. In light of this topic, this side of the scale is not worth much consideration (and those owners' requests are denied!). It is the other side of this spectrum that I find valuable scenarios worth contemplation.

From every objective standpoint, it was clear that Casey was dying. She was a very old dog who hadn’t eaten in at least a week. The owners continually brought her in to address her appetite, with little success. She could barely walk and, at times, didn’t have the energy to lift her head off of the floor. Time’s passing did not seem to calm the panic in her owners' heart and we received many frantic calls with demands for us to see Casey on an emergency basis. Despite the fact that everything Casey was experiencing was perfectly normal for a pet at the end of life, Casey’s owners never considered the option of surrender.

After many visits and many treatments with little to no effectiveness, the doctors recommended an ultrasound. The owners agreed and Casey’s ultrasound was done on a Tuesday afternoon. The test showed that Casey was riddled with cancer. She had tumors in many different areas of her body and one had begun to perforate her bowel. Upon looking at the images, there was no reason to question why Casey had been feeling so badly and, in fact, she was getting along quite well given her physical state.

Because Casey’s owners had been caring for this very sick girl for over a week, and because they were so dedicated to her, I had fully expected them to take her home and spend at least one more day with her. Much to my surprise, as soon as they heard the news about the ultrasound, they chose to euthanize her immediately. It struck me that, before they knew what her insides looked like, they had no intention of slowing the “fight” for her life. Once they had the new information, they surrendered with no hesitation. Casey was just as sick before the ultrasound than she was after and yet something had dramatically changed within her owners.

Casey was put to sleep and went very peacefully. The owners felt good about their decision. I certainly never doubted that they made the right choice. It was, however, an interesting example of the fine line between fight and surrender.

Example 2:

When I was dying, someone close to me made an unusual offer. He saw that I was suffering and he told me that, if I ever got to the point where I couldn’t take it anymore, he would be willing to help by finding someone who would euthanize me. I had never even considered the possibility.

My initial reaction was one of shock and horror. “No thanks!” I cried. Despite my physical discomforts, my internal spiritual world was so exciting I wouldn’t dare cut it short. I would some day reach the end of this life chapter and I couldn’t wait to see how it would turn out.

Later, when I was able to think about his proposal, I could see that he had made a bold and brave move out of love for me. I imagine that he fears that part of life, the pain and suffering that comes with dying. Because he loved me, he wanted to offer me what he would want someone to offer him: a way out. It took guts for him to offer me something that many people would want but would never dare to vocalize. He offered me the chance to surrender. I thank him for his compassion.

The Verdict:

When I watch some people clinging to threads of possibility for one more day on earth, I wish they could just surrender and let go of their attachment to living. Sometimes the attachment is more painful than the dying.

At the same time, the only thing I know for sure is that you can never know what you will do until you are actually in the situation. I had proclaimed on more than one occasion that I would never have another transplant. The sicker I got, the weaker this conviction became until I had completely changed my mind. If I had simply “surrendered” in 2003, I would have never gotten a second transplant and I would have missed out on so many wonderful things. I am glad that I kept fighting.

We all have our notions of when it is time to fight and when it is time to wave the white flag. In our culture, there is a strong emphasis put on the value of fighting. In fact, when someone dies, we might say that they “lost their battle” with their disease. I don’t know where that fine line between battle and surrender falls, but I do know that there is a time when giving in grants the most peace. Please don’t ever eulogize that I “lost my battle” with anything! Instead, appreciate that I knew when it was time to stop fighting and let my journey draw to a close.

The question of fight or surrender will always remain just that, a question. Simply knowing that there is an option for both, however, is invaluable.

1 comment:

Femail doc said...

Hi Tiffany,

Thanks for your take on these matters; your observations are always so well worded and your personal experience lends weight to your words.

My mother is dying of multiple tiny strokes, one brain cell at a time. Years ago she stockpiled sleeping pills for just such a scenario, so she wouldn't have to live like this. Now that she's here, the pills are never even mentioned. In fact, she is very keen on living like this, having one more day after one more day to see what happens next and to take satisfaction from the lives of those near to her.

You are so right, you just never know how you will react until you are there. Having those pills around helped her to visualize an end-of-life scenario for years, and now they just aren't part of the reality.

I hope your book is moving towards reality.