5 ms·

My mom struggled with lung cancer for two terrible years with cutting edge treatment, and died badly. My dad cared for her through that, and when his turn came

My mom struggled with lung cancer for two terrible years with cutting edge treatment, and died badly. My dad cared for her through that, and when his turn came five years later, he had no doubts. He refused all but palliative care and died in two months. What he saw once, a physician will see over and over ad nauseam. Having seen one of each, I'm not conflicted over which path I'd take.

drewg123 5y ago
My parents had a very similar experience. I feel your pain, and I agree with your choice
adventured 5y ago
Was it small cell lung cancer? edit: for the remarkably special downvoters (stay classy HN) - that's the type of lung cancer my mother died from, in about 20 months time. You generally can't surgically remove small cell lung cancer. It was particularly brutal, with endless treatment attempts that were physically grueling and minimally effective. It's a highly aggressive cancer with a very low survival rate and few good treatment options. Accordingly, having watched her go through that, I can very much relate to what the parent said.
- Johnny555 5y ago
  While I don't usually comment on downvotes, my guess is that the downvotes are because your question can come off as being insensitive. After someone tells you about the tragic death of both of his parents, maybe don't start a guessing game of what his mother died of even if your loved one died of that same disease.
  - adventured 5y ago
    The barrage of downvotes were typical HN assuming the worst (mindless insensitivity) rather than giving a benefit of the doubt about my intent. This, from HN's guidelines: Assume good faith. You won't see much of that on HN in my very long experience here. People so often jump right to assuming the worst, which is why that guideline exists. The assumption was that I was being insensitive, when the actuality was that I was going to attempt to start a conversation in order to better relate to the parent's story. I could have structured what I said better? That's fair, it happens, and it still doesn't change my intentions, which were positive. It's the classic and true line, that people judge others by their actions without considering intentions and they prefer to judge themselves by their intentions instead of their actions. That's why trying to assume good faith on the part of someone else is so useful on forums. I've got approximately four billion points here on HN, I don't care about the downvotes unto themselves, it's the lack of collegial communication instead of jumping right to a negative triggered reaction (a downvote, which represented a negative, incorrect assumption). You'll notice nobody asked why I was asking that very specific question, there was no attempt to give a shit about that, they all went right to behaving negatively.
    - deleted 5y ago
      [deleted]
    - burnished 5y ago
      >>I could have structured what I said better I think this is the take-away. I'm sorry for your loss, and I suspect that it has made this topic much closer and realer for you than many other people. Whereas we are all familiar with insensitive assholes. It can be challenging to know how to best approach a situation where you think some one is being rude, without also opening yourself up for blame (or verbal abuse), in a calm and constructive manner. Even assuming good faith it would be very easy to see your original un-edited remark as some one curiously gawking at another person's tragedy. I can see that this situation is upsetting for you. It might help to reframe this by recognizing that calm, thoughtful, and articulate communication is difficult.
    - EMM_386 5y ago
      This will likely get downvoted also. The issue is it becoming too meta and veering off topic. I didn't assume anything, and I'm sorry for your loss. But the topic is about how doctors choose to die and it's too off-topic to go into how votes on a particular website are counted. It really doesn't matter.
- bradknowles 5y ago
  Small cell lung cancer is what got my mom. She did chemo, radiation therapy, you name it. In the end, she went into the bathroom, threw up a lot of blood, and never woke up. They didn’t do an autopsy, but the assumption was that the cancer had just gotten too widely distributed throughout her system. But, since she had spent much of her adult life helping my dad with one or the other of his medical problems, and she had been an HR director at Norman Regional Hospital for many years, she did focus on trying to keep the best quality of life that she could, right up to the end. The irony was that she had quit smoking thirty years earlier. It was her sister that did her in. Since the sister was in stage 4 of stomach cancer, they let her smoke in her hospital room. And my mom was the primary caregiver who slept in that room and was there pretty much 24x7. So, her second-hand smoke is what got my mom. Definitely focus on quality of life. Whatever you’ve got left, you should try to make those your best days, weeks, months, or years yet.
WalterBright 5y ago
On the other hand, my sister was told to put her affairs in order. She did the major surgery and the chemo, and just passed 10 years cancer free. Odds of her outcome were something like 5%. She's well aware of how lucky she is.
- foolinaround 5y ago
  the age of your sister at the time of sickness should factor in, right?
  - magicalist 5y ago
    And the type of treatment
    - WalterBright 5y ago
      Multiple operations to remove metastasized tumors followed by conventional chemo.
  - WalterBright 5y ago
    49
- chucksmash 5y ago
  Posted article doesn't seem to be accessible right now so apologies if I'm repeating something it says, I couldn't RTFA. "Being Mortal" by Atul Gawande talks about this. He mentions Stephen Gould's essay, "The Median Isn't The Message," in which Gould says: > For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light. Which is an idea I think meshes very well with the strategy of chasing low probability , high reward outcomes. Gawande's response makes a lot of sense to me personally: > There is almost always a long tail of possibility, however thin. What's wrong with looking for it? Nothing, it seems to me, unless it means we have failed to prepare for the outcome that's vastly more probable. The problem is that we have built our medical system and culture around the long tail. We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets—and have only the rudiments of a system to prepare patients for the near certainly that those tickets will not win. Hope is not a plan, but hope is our plan. He also talks about several patients he treated through the years who suffered through futile treatments while trying to become one of the lucky ones and lost what quality of life they might have had in their dwindling time. I'm glad your sister was one of the lucky ones who had a good outcome as opposed to going through the major surgery and chemo and being one of the 95%. It also seems to me that a different mindset in these sort of situations that educate patients on palliative options and try to make their remaining time as good as it can be would reduce much unnecessary suffering.
refurb 5y ago
The point is you don’t know which path you’ll go down until you go down it. Look at any cancer drug trial and there is a massive spread in outcomes. Some people take a drug and die with horrible side effects in 2 months, others live 10 years with mild side effects.
- kixiQu 5y ago
  There's a lot of comfy middle ground between "I do not want any medications; I will go home and wrap myself in a linen shroud" and "please break my nonagenarian ribs then barely sustain me in purgatorial discomfort as long as technology allows". And yet one of those endpoints has become the legal/social default.

drewg123 5y ago

My parents had a very similar experience. I feel your pain, and I agree with your choice

adventured 5y ago

Was it small cell lung cancer? edit: for the remarkably special downvoters (stay classy HN) - that's the type of lung cancer my mother died from, in about 20 months time. You generally can't surgically remove small cell lung cancer. It was particularly brutal, with endless treatment attempts that were physically grueling and minimally effective. It's a highly aggressive cancer with a very low survival rate and few good treatment options. Accordingly, having watched her go through that, I can very much relate to what the parent said.

Johnny555 5y ago
While I don't usually comment on downvotes, my guess is that the downvotes are because your question can come off as being insensitive. After someone tells you about the tragic death of both of his parents, maybe don't start a guessing game of what his mother died of even if your loved one died of that same disease.
- adventured 5y ago
  The barrage of downvotes were typical HN assuming the worst (mindless insensitivity) rather than giving a benefit of the doubt about my intent. This, from HN's guidelines: Assume good faith. You won't see much of that on HN in my very long experience here. People so often jump right to assuming the worst, which is why that guideline exists. The assumption was that I was being insensitive, when the actuality was that I was going to attempt to start a conversation in order to better relate to the parent's story. I could have structured what I said better? That's fair, it happens, and it still doesn't change my intentions, which were positive. It's the classic and true line, that people judge others by their actions without considering intentions and they prefer to judge themselves by their intentions instead of their actions. That's why trying to assume good faith on the part of someone else is so useful on forums. I've got approximately four billion points here on HN, I don't care about the downvotes unto themselves, it's the lack of collegial communication instead of jumping right to a negative triggered reaction (a downvote, which represented a negative, incorrect assumption). You'll notice nobody asked why I was asking that very specific question, there was no attempt to give a shit about that, they all went right to behaving negatively.
  - deleted 5y ago
    [deleted]
  - burnished 5y ago
    >>I could have structured what I said better I think this is the take-away. I'm sorry for your loss, and I suspect that it has made this topic much closer and realer for you than many other people. Whereas we are all familiar with insensitive assholes. It can be challenging to know how to best approach a situation where you think some one is being rude, without also opening yourself up for blame (or verbal abuse), in a calm and constructive manner. Even assuming good faith it would be very easy to see your original un-edited remark as some one curiously gawking at another person's tragedy. I can see that this situation is upsetting for you. It might help to reframe this by recognizing that calm, thoughtful, and articulate communication is difficult.
  - EMM_386 5y ago
    This will likely get downvoted also. The issue is it becoming too meta and veering off topic. I didn't assume anything, and I'm sorry for your loss. But the topic is about how doctors choose to die and it's too off-topic to go into how votes on a particular website are counted. It really doesn't matter.
bradknowles 5y ago
Small cell lung cancer is what got my mom. She did chemo, radiation therapy, you name it. In the end, she went into the bathroom, threw up a lot of blood, and never woke up. They didn’t do an autopsy, but the assumption was that the cancer had just gotten too widely distributed throughout her system. But, since she had spent much of her adult life helping my dad with one or the other of his medical problems, and she had been an HR director at Norman Regional Hospital for many years, she did focus on trying to keep the best quality of life that she could, right up to the end. The irony was that she had quit smoking thirty years earlier. It was her sister that did her in. Since the sister was in stage 4 of stomach cancer, they let her smoke in her hospital room. And my mom was the primary caregiver who slept in that room and was there pretty much 24x7. So, her second-hand smoke is what got my mom. Definitely focus on quality of life. Whatever you’ve got left, you should try to make those your best days, weeks, months, or years yet.

WalterBright 5y ago

On the other hand, my sister was told to put her affairs in order. She did the major surgery and the chemo, and just passed 10 years cancer free. Odds of her outcome were something like 5%. She's well aware of how lucky she is.

foolinaround 5y ago
the age of your sister at the time of sickness should factor in, right?
- magicalist 5y ago
  And the type of treatment
  - WalterBright 5y ago
    Multiple operations to remove metastasized tumors followed by conventional chemo.
- WalterBright 5y ago
  49
chucksmash 5y ago
Posted article doesn't seem to be accessible right now so apologies if I'm repeating something it says, I couldn't RTFA. "Being Mortal" by Atul Gawande talks about this. He mentions Stephen Gould's essay, "The Median Isn't The Message," in which Gould says: > For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light. Which is an idea I think meshes very well with the strategy of chasing low probability , high reward outcomes. Gawande's response makes a lot of sense to me personally: > There is almost always a long tail of possibility, however thin. What's wrong with looking for it? Nothing, it seems to me, unless it means we have failed to prepare for the outcome that's vastly more probable. The problem is that we have built our medical system and culture around the long tail. We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets—and have only the rudiments of a system to prepare patients for the near certainly that those tickets will not win. Hope is not a plan, but hope is our plan. He also talks about several patients he treated through the years who suffered through futile treatments while trying to become one of the lucky ones and lost what quality of life they might have had in their dwindling time. I'm glad your sister was one of the lucky ones who had a good outcome as opposed to going through the major surgery and chemo and being one of the 95%. It also seems to me that a different mindset in these sort of situations that educate patients on palliative options and try to make their remaining time as good as it can be would reduce much unnecessary suffering.

refurb 5y ago

The point is you don’t know which path you’ll go down until you go down it. Look at any cancer drug trial and there is a massive spread in outcomes. Some people take a drug and die with horrible side effects in 2 months, others live 10 years with mild side effects.

kixiQu 5y ago
There's a lot of comfy middle ground between "I do not want any medications; I will go home and wrap myself in a linen shroud" and "please break my nonagenarian ribs then barely sustain me in purgatorial discomfort as long as technology allows". And yet one of those endpoints has become the legal/social default.