When doctors talk about personal experiences with dying, we learn how experts about the questions and decisions around treatment and comfort care. How do doctors spend their last days? What care do they think is best?
Oliver Sacks famously told vivid stories about unusual medical cases and made himself the story. He had the courage to write about living while dying from cancer.
Sacks admitted that he was afraid in “My Own Life,” an opinion piece published by the New York Times on February 19. Sacks had a rare eye tumor removed nine years ago, but cancer had continued to take hold and had spread to his liver.
Along with fear, sadness and grieving coming with the dying process. “When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death, Sacks said.
“It is up to me now to choose how to live out the months that remain to me. I have to live in the richest, deepest, most productive way I can,” he said.
Living while dying
Based on Sacks’ writing and a memorial message on the Sacks Foundation website, he did all the things he loved with people he loved — daily swims, travel, spending time with people he loved, and playing the piano.
He also threw himself into work — writing up until the end. He gave Times’ readers three long essays before he died and a posthumous article “Urge” was published in the New York Review of Books. Other writing remains to be published, including several partially-done books.
In contrast, young neurosurgeon Paul Kalanithi took things a bit more easy. He wrote “Before I Go” on living with metastatic lung cancer before his death on March 9:
The most obvious might be an impulse to frantic activity: to ‘live life to its fullest,’ to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time, it also limits your energy. But even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder, some days I simply persist.
Kalanithi said he plodded, but he welcomed a baby daughter and wrote a book, “When Breath Becomes Air,” during the two-year period from diagnosis to deth.
End of life treatment
Some may be surprised about the amount of treatment physicians get for terminal illnesses. Family medicine doctor Ken Murray revealed in “How Doctors Die” that doctors get much less treatment at the end as compared to other Americans. “Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits.”
Sacks wrote on July 24 in Times’ opinion piece, “My Periodic Table,” that he underwent embolization therapy that rid his liver of metastases — giving him an “intermission” rather than a remission.
During that time he saw patients, wrote, and visited his homeland England with partner of six years Billy Hayes. Sacks wrote: “People could scarcely believe at this time that I had a terminal condition, and I could easily forget it myself.”
Similarly, Kalanithi welcomed his temporary period of wellness, but also felt sadness. “Time for me is double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence — and eventually, death,” he wrote.
When medical treatments have been exhausted, palliative or comfort care moves to the forefront. Hospice care has been found effective in relieving pain and allowing people to die at home. Murray said: “Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days.”
When Sacks’ health began to decline in May and June, he still was able to celebrate his 82nd birthday “in style.” He described the symptoms of his cancer with the chills, nausea, night sweats, and tiredness. He said:
I continue to swim daily, but more slowly now, as I am beginning to feel a little short of breath. I could deny it before, but I know I am ill now. A CT scan on July 7 confirmed that the metastases had not only regrown in my liver but had now spread beyond it as well.
In his final essay for the Times, “Sabbath,” Sacks wrote:
And now, weak, short of breath, my once-firm muscles melted away by cancer, I find my thoughts, increasingly, not on the supernatural or spiritual, but on what is meant by living a good and worthwhile life — achieving a sense of peace within oneself.
Epilogue
On August 30, Dr. Oliver Sacks died at his home in Greenwich Village with his partner Bill Hayes and collaborator Kate Edgar by his side, according to CNN.
Dr. Paul Kalanithi died on March 9 at age 37 with his family around him, according to an obituary in Stanford Medicine. He is survived by wife Lucy and daughter Elizabeth Acadia “Cady” Kalanithi was born on July 4, 2014.
