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I’ve long been convinced that, at least to some extent, and within the boundaries imposed by the aggressiveness of their cancers, my patients die only when they’re good and ready to. For many, that time occurs after they have achieved a specific goal. Perhaps it’s the birth of a grandchild, or that grandchild’s college graduation. Maybe it’s seeing the long-lost sibling a patient has been feuding with for years. Parents always wait to say goodbye to their children: I have seen patients, even those moribund and comatose, linger for days until a daughter or son from overseas arrives.
One patient, a man in his late 60s who had multiple cancers, told me his goal was to walk his granddaughter down the aisle at her wedding. He and his wife had raised her while their daughter, who had gotten pregnant in her teens and then became addicted to drugs, struggled to get her life back in order.
After surviving colon cancer years earlier, he developed lung cancer. Prior to treating that cancer, the lung cancer specialist referred him to me when he noticed the patient had abnormal blood counts. A bone marrow biopsy revealed both acute leukemia and another bone marrow cancer, multiple myeloma.
Three cancers at the same time, four in total, but you’d never know it from his attitude.
Determined, positive, and uncompromising: none of these cancers would keep him from that wedding. The chemotherapy knocked his blood counts down, but didn’t do much to kill the leukemia. The lung cancer spread to his brain, leaving him partially paralyzed. We treated that well enough, with steroids, so he could walk again.
“You should have heard the gasp from everyone in the church when he came through those doors with our grand- daughter,” his wife told me. “No one thought he would be there.”
I saw him one last time after the wedding. He wore a sweatshirt with a photo transfer of him and his granddaughter walking down the aisle. The caption read “Mission Accomplished.”
This kind of “will-to-live-until” phenomenon has even been studied. Investigators from Ohio State University explored whether people with cancer die soon after they achieve a milestone, which for the study was defined as a birthday, Thanksgiving, or Christmas. They examined death certificates from over 300,000 people who died with cancer in Ohio during an 11-year period, from 1989 to 2000. It was a negative study, though; people with cancer were no more likely to die after these events than before.
The authors concluded: “Analysis of thousands of cancer deaths shows no pattern to support the concept that ‘death takes a holiday.’ We find no evidence that cancer patients are able to postpone their death to survive Christmas, Thanksgiving, or their own birthdays.”
But I’ve always felt the study focused on the wrong “milestone.” I haven’t looked forward to a birthday for decades, and when I did it was only at seminal transitions: from 15 to 16, when I could finally drive my mom’s Toyota Tercel, and 20 to 21, when I could hold my head high as I walked into a bar in my home state of Rhode Island using my real driver’s license, not the one claiming I was from Lumberton, New Jersey. Holidays are a mixed blessing for even the most hale and hearty of us, particularly if they involve travel with young children hopped up on sugar, and an unwelcome break from routine.
The other people I’ve witnessed who seem to have some say in when a dramatic, health-related life event will occur are pregnant women. I can’t count the number of times during my wife’s pregnancies when someone commented that she would go into labor only after she’d “finished nesting”— that is, preparing for the birth and completing other tasks she needed to accomplish before going on maternity leave. Put these two together—a person on the cusp of dying, and a pregnant woman at term—and we have the makings of a serious stalemate.
A few years back, I cared for a woman who had end-stage cancer. She had slipped into a coma, but before doing so declared that she wanted to live long enough to see the birth of her first grandchild. Her 40-week-pregnant daughter, who was by her side daily in the hospital, declared that she would not leave her mother to go into labor, for fear that she wouldn’t be present when her mother took her last breath.
We witnessed this standoff for almost two weeks, until the daughter’s obstetrician felt it was too dangerous to let the pregnancy continue any longer. The daughter left, reluctantly, to have a Caesarian section, returned hours later with the baby in her arms, and her mother died later that night.
I think I would live long enough for one of those impossible-to-measure-in-a-study family-life events.
Some people have such tight relationships with sports teams that those teams figure prominently in death plans. One famous Cleveland fan, Scott Entsminger, made a request in his Columbus Dispatch obituary that six members of the Browns football team serve as his pallbearers“so the Browns can let him down one last time.” It wasn’t a complete surprise, then, for David, with his family all around him, to focus his death plans on the Cleveland Indians.
“Goodbye, and good luck, David. It’s been really nice getting to know you.” As I rose from the chair, I held out my hand to shake David’s. He took hold of it, and my gaze, for a few final seconds. We both knew this would be the last time we would see each other. I hugged Betty and Susan, and Rachel hugged Eric goodbye.
He made it to see the Indians opener on TV, and died the following day. The Tribe even managed to win the game, in 10 innings.