Remembering to Laugh
Don S. Dizon, MD, FACP
04 Jul 2012 10:35 AM
One of the best things about blogging for ASCO is the feedback from others, which in honesty, I never counted on. For example, I’ve “met” Terry Hourigan through ASCO Connection. He is a nurse who provides care in home-based infusion services to patients, many in hospice.
During a recent exchange, Terry wrote, "I have always depended on seeing something funny or happy in every situation. If the patient and family and I laugh together, it feels much freer and everyone relaxes a little. I'm still able to do it with some, and we laugh together almost every visit, but [with some of my newer younger patients and especially their parents] I feel close to boundaries a lot."
I have been thinking about this since Terry mentioned it—about what goes on after someone reaches the end of their life, and when the process of dying actively is upon her and her family. Could there ever be an appropriate time to laugh? Is it okay to find humor in the worst of times for any family?
It reminded me of one very special woman. I had met Jean* after her uterine cancer had recurred. She was in her early 60s, a chaplain and a mother, with a very large extended family. She was smart and in charge—aware that her cancer was not curable, that the only hope treatment held was to reduce her abdominal pain and maybe help her live a while longer. Her faith was strong, and more important than medicine.
I offered her a clinical trial and she agreed to participate. Unfortunately, as weeks passed, the treatment ended up being worse than her disease. Ultimately, I recommended treatment be discontinued—I was seeing her wither away and if I did not stop treatment, I feared she would die. It was not at all what I or she had hoped for.
I had hoped that her decline was due to the therapy she had received on study, but as time passed and she did not improve, I realized that she was getting worse due to disease progression. Ultimately, a follow-up CT scan confirmed this—she had significant and diffuse disease progression within her liver, lungs, and abdomen.
When I met with her and told her the results, she declared she was through with treatment. "I'm dying. I’d like to enjoy it. It's in the Lord's hands."
Knowing Jean as well as I had come to know her, I was neither surprised nor shocked by her decision. At her request, we met with her family because she wanted them to hear from me that she was terminal. A lot of questions were asked and tears were shed. Through it all, the strongest person in the room was Jean.
About a week later, Jean came to see me again. She looked slightly annoyed, and I had assumed that it was because I was running late.
"I'm about to kick everyone out of my house," she declared.
A bit taken aback, I asked her, "What's happened?"
As it turns out, the take-home message her family had received from me was not that Jean was dying, with time measured in weeks and maybe months, but that Jean was almost as good as dead. She would wake from a nap or first thing in the morning with concerned faces staring at her, almost lying with her in bed. She had family members fly in to tell her, "you were always good to me," referring to her in the past tense. Her family was choosing her clothes and dividing up her possessions—all while she sat there in front of them. She had had enough.
"I'm not dead yet!" she told her family, exasperated. "I'm right here, sitting on my couch, trying to watch Oprah! Would you just let me watch Oprah without staring at me, waiting for me to breathe my last breath?"
"But, Dr. Dizon said you'd be dead in days," her niece had said. "It's been a week already."
"DR. DIZON DID NOT SAY THAT! HE SAID I HAD WEEKS OR EVEN MONTHS. HE AIN'T GOD. I DONT KNOW WHY YOU THINK HE IS!"
"Well, he is a doctor," was the niece's only reply.
“SO?!” Was her only reply as she stormed out of the room.
As she told this story, she laughed. She laughed so hard she could barely finish talking. I got so caught up in her laughter that I found myself laughing too.
I think we laughed because we both knew she was still here, very much alive. We laughed because we knew that her time was not in my hands, nor in hers.
However, I am certain that God was right there too—encouraging us to laugh and smile and share a unique experience at the end of her life.
*Name and details have been changed to protect the identity of this patient.
CommentsNumber of Comments: 2
Monday, July 09, 2012 1:03 PM
As the daughter of a patient (my mother) who passed in January, I can tell you we laughed together countless times during her treatment, big hearty tear-induced laughter -- about her hair, about the absurdity of hospital food, about current events. During her last days, when she could hear but not respond, we continued to tell funny stories to keep our spirits up. There's always time for laughter, it is for many, "the best medicine."
Tuesday, July 10, 2012 1:34 PM
Dear Lauren, thank you for your comments. Your mom was fortunate to have you there to laugh by her bedside. I think your lesson is one that will be forever true. It certainly was the same with my family, when my dad passed away. Laughter certainly can be the best medicine and for us who must go on, the foundation for a truly lovely memory. D