Tuesday, August 16, 2016
THE ART OF DYING
My mom was re-diagnosed with breast cancer in 2010 at the age of 65. She had been in remission since her initial diagnosis in 1994 when she was 49. At that time she underwent a lumpectomy, chemotherapy and radiation. They also removed her lymph nodes, where they found cancer. The hope was that the chemotherapy would eradicate any renegade tumor cells that had escaped into her circulation. A few years later we had practically forgotten about her condition, such was her good health.
When she started having trouble breathing shortly after becoming a senior citizen, I gave her lungs a listen and it didn't sound like she was moving any air. Her doctor ordered an X-ray which revealed fluid filling the left side of her chest and collapsing her lung. The cancer was back, and had spread to her chest. Weekly drains followed, sometimes twice a week, and when the pleural effusions spontaneously resolved after 6 months we were surprised and relieved. By then her oncologist had put her on oral chemotherapy as well as an anti-estrogen to starve the spread of her specific breed of cancer, known as estrogen receptor positive. Additional scans revealed that the cancer had also metastasized to her bone. We returned home from the doctor's and I looked up metastatic breast cancer with pleural effusion in my pathology textbook. She would likely pass within 5-10 years.
For the next 5 years my mom lived with a semblance of normalcy. Working as a fine jeweler in Beverly Hills, running errands. Cleaning house. Going to dinner. I put her on a vegan diet and cut out alcohol and processed foods as well as meat and dairy, the major source of estrogen in the diet. Estrogen is also secreted by the ovaries and by fat cells, but as a post-menopausal vegan her production of the female hormone was minimal. I made her fresh vegetable juices every day consisting of carrot and apple and ginger with beet and cabbage and lemon. And we cherished every moment.
But in the summer of 2015 she started having pain and fullness in her belly, along with constipation. At her doctor's insistence I took her to the emergency department where we waited all night to be evaluated. The cancer had spread to her large intestine and was obstructing the passage of stool. Before long surgeons would remove her descending colon and attached a colostomy bag just to the left of her belly button. After a month-long hospital stay she made it back home and over the course of a couple months regained the weight she had lost and accustomed herself to daily colostomy changes. She found it inconvenient to work out and could no longer wear a bikini. But it was winter, so this didn't matter.
This past May the chemotherapy was no longer working. Her tumor markers were slowly going up, and the fullness returned to her abdomen. So she asked to stop her anti-estrogen shots, which were very painful. The doctor decided to stop all oral medication as well and offered IV chemotherapy, but after undergoing this experience in 1994, and losing her hair, and feeling nauseated and grumpy all the time, she said it was not for her.
So at my dad's suggestion I put her on alternative treatments, everything that we could find that might halt cancer's spread, from melatonin to high dose vitamin D to baking soda and turmeric. Nothing worked, except for the weekly drains of the fluid in her abdomen, which provided symptomatic relief, but made her vomit. And we watched her slowly descend into more and more pain. June and July were rough. She went from 135 lbs to 100 lbs. She could keep nothing down. And the discomfort was terrible. Her primary care doctor ordered pain medication, morphine and Valium, but advised that once she started taking them her body would shut down and the end would quickly arrive. Things were happening so fast. My mom started feeling desperate. She didn't want to die. Should she start IV chemotherapy, despite its being effective in only 25% of patients?
I remembered reading the lives of the saints. There was a man who died for his faith and was buried alive. But when they dug up his body they saw dirt and blood beneath his fingertips. He had desperately tried to claw his way out of the grave, proving he hadn't come to terms with his end, he lacked faith. I told my mom this. I wanted her to be dignified to the end. She had been my hero for so long, I wanted her to die my hero too. I showed her a picture of the holy man Ramana Maharshi 10 days before he died of metastatic cancer. He was dressed in white and lying in bed. Such a look of serenity on his face. This is you, mom! I reminded her of Justin, my brother. He was diagnosed with cancer at 22 and refused surgery. As he slowly deteriorated over the course of 6 months he never had second thoughts. He taught us how to die, mom. He was a true hero! How could you accept the death of your own son and fear your own? This got through to her. She decided to remain firm and steady till the end. She thanked me for the pep talk.
What she did want was to party. So we decided to throw her a bash. Celebration slash graduation. She always liked Prince, sang his lyrics, "Life is just a party and parties aren't meant to last." Eighty people attended. Friends, loved ones. The estranged. Friends of mine from high school I had lost contact with. I now know why we die. It is so that our loved ones may come together again. She got to talk to everyone. We did her nails and eyelashes and dressed her in the finest garment, and in bed she watched the festivities. It was like a family reunion! As the guests left she started taking pain medication. Over the course of 6 hours she took the daily maximum of morphine and Valium. Such a meager dose would merely put to sleep a healthy person, but in a malnourished 71-year-old with end stage illness, it was enough to push her over the edge.
On Monday she flitted in and out of consciousness, saying "wow" and "we did it" and "I love you." I carried her outside so she could spend her last moments of lucidity in her beautiful garden. She used to tell me how when I was born and they put me on her tummy in the delivery room, I looked right into her eyes as if to say, "There you are!" And here we were, mother and son, some 44 years later, staring into each other's eyes, not at the beginning of my life, but at my mother's end. The feelings that poured out of me reduced me to a torrent of tears. And yet I smiled through them, for my heart was filled with joy at the beauty of the cycle of life.
Before we brought her back into her bedroom, she looked around with bright, clear eyes. Her final words were, "Who am I?" The question of all questions. She had become undifferentiated consciousness, discarding all individual identity. Like a newborn before it is given a name and with it a personality. Like me, when I first looked into her eyes.
Her breathing became slower and more intermittent, and she didn't regain consciousness again before leaving her body at 2:30 pm on Wednesday, August 10th. She was surrounded by loved ones, and died completely at peace.
I got to tell my mom how much she meant to me, thank her, love her, hold her. Sob in her arms. No regrets. This is how people should die, not in a sterile hospital surrounded by strangers, but in the comfort and familiarity of the home, in the presence of the near and dear. Cancer really is a wretched disease, but it provides this opportunity: to know when is the end. How many of us get to wake up to what we know will be the last party we'll ever experience on Earth? I got to enjoy this adventure with my mom, and gratitude fills my heart. May her memory live on, and her example inspire others.
RIP Laraine Pieri Dave (4/24/45-8/10/16). How I love you.