Learning to Live: Reflections on Caring for Patients at the End of Life

Learning to Live: Reflections on Caring for Patients at the End of Life

International Perspectives

Mar 06, 2018

Dr. Manglio Miguel RizzoBy Manglio Miguel Rizzo, MD, PhD

Three weeks ago I met a man with his wife and daughter. He had been busy with plenty of projects and was healthy until two months ago, when he started to lose weight and feel fatigue.

When I met him as a patient, he had been recently diagnosed with stomach cancer with bone metastases and bone marrow infiltration. He had a good performance status and indeed he said he felt “good,” but we all knew it would be hard for the family to pass through this experience. We talked about life, stomach cancer, treatments, toxicities, and… death.

When I was talking with him about death, there appeared into my mind two ideas: vacuum or freedom. Vacuum where there is nothing, a deep empty space, a darkness. Or freedom where there is light, brightness, peace, love.

Nowadays, death is no longer just annoying, unjust, and inopportune—it is increasingly inadmissible. In a consumerist and mechanized society, people’s faith is often put on the technoscience that is expected to deprogram even the inevitable. They cling to the drugs, syringes, tubes, and machines, and place their hope there. As doctors, it is difficult for us to face the impotence of not being able to do something in order to cure our patients. However, there are those individuals who demonstrate that it is possible to integrate the goodbye into a full existence. They live each day doing what they love and prepare themselves for a profound change, like butterflies which simply change their state not their nature.

I sometimes hear about a “death with dignity,” and I ask myself what makes a death dignified? I feel the answer is in life, not in death, knowing each second of your life is important to someone, that you are worthy not for what you do or have but for what you are. Each day I deal with patients who prefer to ignore their disease. Others face it and dream of “winning” against their cancer, putting their hope in a time when their disease would be defeated. But, sometimes, I could see people who live despite their disease. I think each one lives as best they can.

My patient with gastric cancer did die, eventually, surrounded by his wife, his son, his daughter, and others whom he loved. He could change his state with peace because he had a good reason to live. As a medical oncologist, I try to walk alongside of my patients being part of their life and helping them to live it well.

Dr. Rizzo is a medical oncologist at Hospital Universitario Austral in Buenos Aires, Argentina. He is a 2017 recipient of ASCO and Conquer Cancer’s International Development and Education Award.


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