I understood things were not going to be all right the moment the plane landed. It was a small commuter airport in Southern California. We'd made our descent over lemon orchards and a bright bend of the Pacific, touched down, taxied to a stop in front of the terminal. I saw my father leaning against a chain-link fence. For the first time in my life I was watching him cry. We were a family who jogged, watched our cholesterol, and scheduled annual checkups. Dying took us by surprise. A few weeks before, my mother had complained of a pain in her ribs. She was a three-times-a-week golfer, a yoga enthusiast, an ocean swimmer, a woman who at 72 looked easily 10 years younger. She assumed she had merely pulled a muscle. But the pain refused to disappear. She scheduled an appointment with the family doctor. "I can't see what could be wrong with someone as healthy as you," he said.

But the doctor ordered an MRI, and then a CAT scan and a biopsy. What they revealed was the reason my father stood among strangers crying. An aggressive adenocarcinoma of unknown origin -- perhaps breast, perhaps lung, we never found out -- had metastasized throughout my mother's rib and spine.

"I think your mother is going to have a lot of trouble with this cancer," said the oncologist when we got to the hospital.

A lot of trouble. That wasn't the half of it.

Sitting in a quilted nightgown in her hospital bed, my mother was tanned, cheerful, and stunned. A few weeks earlier, she and my father had been planning summer cruises. Now they were planning the remaining months of her life.

I asked her how she felt. "Mad," she said. That was it. We would always have a hard time discussing her illness. Optimism was such a family creed, we lacked the vocabulary for crisis. But my mother did make it clear that she did not want to remain in the hospital. She wanted to go home.

Until that moment "hospice" was a word I associated with made-for-TV movies in which guest stars died uplifting deaths in garden settings. Now, we were told, hospice could help us care for my mother at home. Suddenly, and for the next few months, hospice became the center of our lives.

Our house acquired the grim energy of a military headquarters. We accumulated bedpans, walkers, safety railings. We installed a buzzer my mother could press when she required pain medication; its alarm sawed the air like the horn on a navy submarine. Chilling in the refrigerator was an array of narcotics I had not realized private citizens could legally possess. We had a new bed: a heavy electric device designed to lift my mother's frail body on a cushion of air, with coils and baffles that hissed as malevolently as Darth Vader. Most important, we had the hospice staff -- doctor, nurses, social worker -- making sure my father and I could handle the bed and bedpans, the narcotics and buzzers, the reality of my mother's dying.

March, April, May. The cancer was, as the oncologist promised, aggressive. Each month, each week, each day was a diminishment. My mother was confined to downstairs, then to her bedroom and bathroom, then to her bed. My father brushed her hair and massaged her legs and feet. The hair turned brittle and fell out; she lost all feeling in her legs. I read to her. We examined family photo albums. Shots from the '50s and '60s: my parents, glamorous at the Coconut Grove, laughing with golf buddies during some Sweethearts' Tournament. In later snapshots I was present: cradled by my mother at Bryce Canyon in Utah, capped and gowned beside her at college graduation.

Sometimes as my mother and I flipped through these Kodak moments of a life now drawing to a close, I would reassure myself: At least we are home. Home was nothing fancy, just a Southern California beach house, the kind of place where you stowed your surfboard in the carport and then tracked sand into the living room, and when you opened any window you heard the sound of the sea. But my mother loved it here. How well we were doing, I told myself, that she could remain.

Or I thought we were doing well, until one night I was driving up the Pacific Coast Highway. It had been a lousy week. My mother was paralyzed now, and drifting in and out of consciousness. My father and I had argued. It was suddenly clear that despite everyone's hard work and good intentions she was going to die, and sooner than we had thought possible. Each half mile I stopped the car and threw up at the side of the road. By the time I reached Mugu Rock, a plug of granite jammed into the Pacific, I was propped against the car thinking, "She can't go on, I can't go on, none of us can go on." For the first time in my life I considered the act usually referred to as euthanasia. No details entered my mind, just the simple fact: My father and I could end this.

I expected a thunderclap. I possessed -- still possess -- a strong if untutored religious faith and a clear sense that ending someone's life was a sin. Yet there I stood thinking any sin would be preferable to continuing this nightmare.

The moment passed. I did nothing. The ending came on its own soon enough. My mother grew weaker, aging with the withering that cancer brings. She drifted away. It was as terrible and powerful a thing to witness as seeing someone pulled from you by the tide. She died on Father's Day. I had bought my father a card and bottle of cognac that we were drinking when we heard her breathing stop.

This was a death whose particulars were orchestrated by a hospice program. For three decades the hospice movement has been aiding families like mine. Hospice offers the hope that death need not be painful, impersonal, or entangled in technology. It offers the hope that death, while inevitable, need not be unendurable.

"What do Americans say they most want to avoid?" asks Ira Byock, a Missoula, Montana, physician and former president of the American Academy of Hospice and Palliative Medicine. "They don't want to die in pain. They don't want to die isolated and abandoned. They don't want to be a burden -- particularly a financial burden -- on their families." Hospice, Byock and his allies maintain, can ease all of these fears.

One way of understanding hospice is that it is the only medical institution designed solely for the dying. When a patient is given a terminal diagnosis of six months or less and agrees to hospice care, he or she abandons aggressive treatment of the disease. Generally, patients will not receive chemotherapy or blood transfusions nor be connected to respirators or feeding tubes, although some of these treatments may be used as palliative care. Typically, they will be cared for not in a hospital or a nursing home but in their own homes.

In giving up a hospital's aura of stainless steel crisis, patients and their families put their faith in the ministrations of the hospice team -- physicians, nurses, nurse's aides, and social workers, all trained in end-of-life care. The team makes sure that symptoms are managed, pain is controlled, and family members are not shattering under the pressure of illness. Medicare and private insurance plans normally cover the visits.

My father and I knew nothing of hospice before we scanned the local program's tasteful pastel brochures. We knew nothing about anything. To imagine how ill-suited we were to tending a terminally ill patient full-time, you would have to imagine Abbott and Costello starring in "ER."

But we managed. We got better at it. A few times a week (more often as my mother neared death) someone from hospice would visit to check that my mother was reasonably comfortable, to monitor the cancer, to see whether my father and I were beginning to crack. Our favorite was the social worker: a dark-haired, athletic woman not unlike my mother in her youth. She radiated the kind of good health you think will rub off on you, and she did not seem bothered that when my mother and I spoke with her we often began to cry.

Nurses and nurse's aides were more problematic. We were hard on them. One nurse arrived a half-hour late. We demanded a replacement. Another was brusque. We replaced her, too. Later I understood that we'd been focusing our anger on these people. But eventually we found the perfect nurse, who bustled pleasantly and told my mother how pretty she looked. She knew what her patient needed to hear.

Our biggest fear was that my mother would experience intolerable pain. But my mother did not suffer horribly. That, say hospice experts, is usually the case. "Pain management has gotten much better," says Dr. Laurel Herbst of the San Diego Hospice. "We have a much clearer understanding of the physiology of pain. Ninety-five percent of patients stay awake, alert, and pain-free." Prescription painkillers, including morphine, can lessen physical discomfort; steroids can lift, a bit, the dying patient's profound fatigue. If pain increases as death approaches, morphine may be given in higher and higher doses, easing the slide into unconsciousness.

It was in those last days that hospice was of particular help to me. I had not seen anyone die before; in the most rudimentary sense I did not know what to make of the process, did not know what to do. Use swabs to moisten her mouth, the nurse told me. Hold her hand. That breathing you hear is called Cheyne-Stokes; it tells you life is drawing to a close. Her senses are dimming, but hearing will linger. Tell her you love her.

Given our current frustration with the American way of death, hospice should be enjoying a moment in the sun. Instead, the movement often finds itself out in the cold -- not under direct attack so much as misunderstood. As I did, a lot of Americans are standing by a dark highway and saying, "This can't go on." They're wondering if the best death isn't the quickest death. And unless they have a change of heart, the hope that hospice holds out may simply be … beside the point.

Recently, it appears the country has been intent on living out that Woody Allen joke: "It's not that I'm afraid to die. I just don't want to be there when it happens." Organizations such as Compassion and Choices lobby for physician-assisted suicide with the kind of can-do grassroots enthusiasm we expect from the Sierra Club or Mothers Against Drunk Driving. In 1997, Oregon enacted the Death With Dignity Act allowing terminally ill Oregonians to voluntarily end their own lives through the use of physician-prescribed lethal medications. Proponents pushed their arguments up to the U.S. Supreme Court,. which upheld the Oregon law in a 6-3 decision in January 2006. And pathologist Jack "Dr. Death" Kevorkian served eight years of a 10-to-25-year sentence for second-degree murder after admitting to having helped more than 100 people end their lives, some by injection, others by inhaling carbon monoxide in the back of Kevorkian's van.

The hospice establishment has taken a strong stand against assisted suicide. In the cases before the Supreme Court, the National Hospice and Palliative Care Organization filed a brief opposing its legalization. After passage of Oregon's Death With Dignity Act, one prominent hospice announced that its staff would not attend patients who wanted to die with a doctor's help.

This antipathy can partly be explained by hospice's roots. Most of the earliest hospices were affiliated with churches, and even today many hospice workers share a moral aversion toward the taking of life. Others look abroad with alarm. They note that the Netherlands, a nation where physician-assisted suicide has been decriminalized, has a weak hospice program, and they worry that legalizing suicide for the dying might similarly weaken hospice in the United States. Psychiatrist Herbert Hendin, author of Seduced by Death, a report on the Dutch experience, sums up the concern: "When assisted suicide is legalized, assisted suicide becomes the easier option, and hospice is a casualty."

Ira Byock's book, Dying Well, tells the story of dozens of hospice patients. Byock doesn't ignore the messy terrifying aspects of death -- the IVs, the incontinence, the pain. But he shows how they can be managed and sometimes transcended. "If you control symptoms," Byock insists, "if you provide basic support to people and families, you see tremendous growth at the end of life. There are robust alternatives to suicide even at the end of life. "

Yet even within the hospice movement, there are people who think assisted suicide and hospice are not mutually exclusive. Among them is Connie Holden, executive director of the Hospice of Boulder County in Colorado and one of the nation's foremost advocates of improving end-of-life care. She was one of a group of hospice professionals who filed a brief in the Supreme Court case arguing that for a small percentage of the terminally ill, suicide should be an option.

"I think hospices sometimes tend to wear rose-colored glasses," Holden said. "I have had deaths in my family that were quite beautiful and gratifying. My father died in a hospice unit, and he had a very peaceful death. I was able to be at his bedside with my two daughters. And we had no desire to hasten it. But for some people, dying is very difficult and quite dreadful."

Difficult and dreadful. That describes my mother's last weeks. Even with the best of assistance, amateur caregivers make mistakes. When the mistakes involve a terminal illness, they can be grievous. In reading the physician's instructions, my father and I gave my mother far too much morphine. The overdose caused her to hallucinate; we thought we might be killing her. She was rushed back into the hospital for a day and then rushed home with accompanying ambulance sirens in both directions.

Other crises were beyond anyone's control. The electric bed had not been engineered to withstand power failures. When our neighborhood went dark one evening, the bed's air-cushioned mattress deflated, dropping my mother's frail ribs and spine onto a spiky nest of coils and pipes. She screamed while my father screamed into the telephone, demanding that the electric company turn on the power right now. It did not.

These were the moments I dwelled on while I stood beside the Pacific Coast Highway, thinking this couldn't go on any longer. These are the moments I relive when I realize that I don't take the strong stand against assisted suicide I once did.

Serious illness is a journey to a foreign country. You don't speak the language, the inhabitants are strangers, you cannot know how you will behave until you arrive. St. Thomas Aquinas condemned suicide because it violates God's authority over life. I believed that. As one of my favorite writers, Flannery O'Connor -- herself the victim of a slow death at a young age -- wrote, "Sickness before death is a very appropriate thing and I think those who don't have it miss one of God's mercies." I believed that, too. Now I believe that there is suffering that is ennobling but also suffering that strips the humanity from a person, that is so unendurable you would be wise not to predict your reaction to it until you confront it.

But inner strength, too, is unpredictable. Often during the past few years of heated debate over assisted suicide, I have listened to people plead that they could not possibly endure the final illness of someone they love -- or endure their own final illness. And I find myself thinking, "Don't sell yourself short. Don't be so sure. It will be bad. But perhaps not as bad as your worst fears." I have reached an age where people I know -- parents of friends, aging relatives -- are receiving terminal diagnoses with some regularity. I find that once I hear the grim news, the second or third sentence out of my mouth is "You'll want to find a hospice program."

For after I stopped by the side of the road and thought I couldn't go on, we went on. That could not have happened without hospice. We struggled through a few more very bad days. But later that week we had a good day. It was May in Southern California, with mustard blazing yellow on the hills and the ocean half in mist and half in sunlight. My mother felt better. The hospice nurse had made her comfortable. The nurse's aide had set her hair.

We made a small celebration of this good day. My father barbecued steaks and tossed a Caesar salad. I hit every florist in town trying to find a dozen yellow roses, my mother's favorite. My mother didn't eat more than a bite of steak and salad, but she said they looked delicious. She liked the roses. We opened the windows, and you could hear the ocean and smell a breeze that carried the start of summer on its shoulders.

This day was not a learning experience for us. It was no grand reconciliation. It did not offer us any moment of particular insight. It was just that the three of us were home, and for one warm May evening we could enjoy a brief piece of our old life together. It had been for all of us a happy life. The kind of life you would want to hold on to for as long as you could.

-- Peter Fish is a freelance writer living in northern California. This story is adapted from an article that originally appeared in Hippocrates magazine.

First published March 20, 2008
Copyright © 2008 Consumer Health Interactive

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