Dying Words - “Extramfinazyx - has; 3331 {fig pace:...

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Unformatted text preview: “Extramfinazyx - has; 3331 {fig pace: angi pint: ef a hismrical adventure navel, as tho-ugh Lafigz‘mdé had; been mowed Tale Twa- j- flifiég a measw'e ‘ I (if '30:: Quixofia _ thrown- £11.” w» 339? Swain} Hm” (London? 0: ieng ago, 1 hay} an agayeintmem a with a gamith who W213 iika ta} die within. a year am} a half. Maxine Emma; i was a nwntycighvymrmmid treame in Begum. The mnlycbfid {)f a miéél’ewchss ; Family, she had mama); bacome engaged to a finanafifl analyst, Fate‘s” \Vayhsxd (all names have been (imagch Om mom— 3 ing in the Shawn, Mmém {Quad :1 smzfil % j lamp in he: bmast, a {mic Eager {inn 3 ‘ gm & biopsy shmvmi that it was $113213: 3: cancer. Furthaz‘ 3mm reveaifld that the 3 came: haé spread t0 fi’hfizm’s $9936: and fiver. which meant €313: aasrgery maid not fuin remove ii", anti Aiméne’s surging; 2‘6— fim‘cd her to me fix themathcm .4: : MMW :mi 1 me: an a brisk autumn afiemwn, He: apgaintmcnt was myiast 0f thfi day, since our cemmsafion was likfily to extend bcymui the hour usualiy 231mm} to {15w gmtienm I had 1:0 expiam l the: gax'ityaf her condition and the pow siblc choéoes she €011.36 make. : {after I. had mined 3212mm, we were gained ii} office byhcr parents; and by Peter“ The); 33.: in a semécérclc facing ma, 3 with Maxine between them} m<weé my Chair our 5mm behind my (icsist. I “Latis m'isw what was {humi at sur- g gem"? began. Maxine reached fbr Peter’s ‘ Emmi. Although I. adcircsstxi M amine, I dis-0 briefly met the gaze og her gat‘ents mm? of Pater, in axis? to engage m’cryww. “The itzifliiezr in d1: brezm Infififiéfiffld 01m Mme tale seta'mifi me snags-am mug: n? the French Revclazianz quéxetic astronpmers embark on a quest io'measare the wand: ' finding hem sciaatfiic triumah and gmat gamma! izgagedy, “A mimfixl am! beaulifisfly Mm scary, m’th pmfui whitiens, and human} fraii'ties.” «Prim»: LEGHT'MAN. gamma 9:: Emszfiem‘s Baum 62 THE NEW” YOfififiH. MOVE“ 25; 2002 ANNALS OF MEQICINE DYING WORDS Haw 55251in (Emmi; deif-wr £75121 news? BY éEfiOME GROOPMAN and 3 half cemfimetms, abeut half an inch, and under the, micmswpe the saw 96! (sacks were activefi' dividmg,” I said. “They shmfici be tmzxrcd aggressiveiy. The tests wt: did on the tumor shmved that it is met sensitive, to humans-3"“ which mled 0m Tamoxifen, a mmman hormoncwbiocker. “The Scan shuwcd that $15“?ch deposits of tumor Imd spread from the breast to the bcmes $51 the neck. There gist: are fear deposits in the lives. W» can treat them with chfimathcmpy, which destmys that came; mils “hamlet may might be Eurki 53g. Tbs: gmd fitZWS is that 32ml stand a w: " smug chance of gaizzg into remissian.” “So that :gzeans aha: shc’ii he 0K3” Maxim’s: mathcr mam My Sam}th fighmned in a famfiiiar 1m}: Thizi pan never get my easier. “Rsxmssion (has not mean cure," I said. “Rwaéséon means that all the can- cer we can measurc disappwm. Therapy is pafliaiivc‘” “W’ha: Ck) yém mean, "pafiiative’? Peter asked in a panicked vfiécc‘ “She. fix tobe wreci,” Maine’s father said. This afiszinctéen was importam, and I needed m mam sure, gently but an- equivocally, that: {he}: uncicrstooé. “Were is :2 very goad Chance thzaf we will. see the metastatic cicposits in your bones and five; shrink; Sigmifimndy, or mmpleteiy «' wi‘i-gwujom {mufikv “in! aEA‘JE 3 ‘IHF 50‘?!” mel: away: Bu? the 1mm immsive (rim—- methampr er radiation availabiezwmgvcn benawmamm magzsplmtwwis not enough So destmy every cmcetr cfli in your body. That is why, Currently, we $321320: say the: $111138! can be cured." Maxim 3M wiihami speaking. Her was flied wézh mags. 21:16: I. gave her some fiSifiifféi. “What is the gain: of tmmmem. them?” I askgci. “13:13iazi0n. That: means; thé‘t? wen if the smear cannot be maxi it can be Cuntmflcé. Tin: besm‘ase “maria; is: $13: the cancer becomes iikt :1 yamsifé‘," I said, purpasafixliy imraiziag a stag? hang-3. “We knock it (301m wiih 333:: they" apy, {mil Empc that it stayS down fer many, many nmnths or years. You can Elm: an aczivc lifcmwwmk, 39g, travel, wimtevc-r. The harm and liver can hmi. find when the cancer satums we mark :0 knsck '21: {imam again. A1} {he while. we iloéd an. m the hope that am cxgrvcrinmmégl {regiment W8} be fixmd the?! .33 Ethic {‘0 eradicate the cancer-"to méy curt: jam.“ Like Mmfim. Mrs. 83:} wwas fighfi Eng hack tears. Her husband smrcd at me. 1 pausad €361?er breaching a samnd crit— icai issue. “X’Vfi {aiked about the baa—rags 8C6“ nitric). But We {IISO have to :mimowicdgc that there a wast-cask: sccnarée.” i had fbumi Quit {his part (if the c ‘5“ ens-Sim was; best «amplified zapldly, if removing an fidhcs'nrc hamiagnm. “The “fora—case scenario is: rim: mixi— mzktci}: the cancer bcwmcs resistant m :11? the 39:1?an [3 we have, and even exper— imema] :‘hen‘spics are :10 use. Mmt pcapk‘ 31%.}? thy; if“ the}! reach a point in the flint-3‘35; when thrcir brain is impairmi, arid than: 120 likeiihomi 0f improving their cps-dig; (2f 5%, than naming should I95: dam: t2} limp :hcm artificizfiiy alive. thrwisgh chine-s iii-(c: x'agp‘irzamrs. Er’s «swam; Mm ma, that I ium'w what yam want Chum if wt: {$12125 that point“ “Kw-WE (Emit thiukf wouici want film,“ she said, hzfltimgiy “Elm mean 53121.: you weak! want (July cemfm“: mmwms to aficviate pairs, anti mt}:ng {ions to prolong; your life, film a mspimwr or cardizzz :‘ewscimtim?’ “Yes. I. think so,” Maxim wh‘m‘pezeii. E nodded. 3313's was hm “enci-of—Zifi: directjw.”l “amid put i: in 'Writéfig is: her mmdimi chafi. “We have 21 phm 0f” therapy and an understanding. Now $655 100% cm the pasifive Sifiu,”1 said. t1}ng to spark some of 211:: dczcrmimition she wouki need in was: to endure {ha months of charm-- {hgmpy ahead. “You are ytmng, you: orgm function is; cxcelicm—dcspke tbs (icgosét's «of tumor, yam“ liver is 31:31 Wank.- ing well, and year blood cman are finewso theft: aver}; {imam {0 think that? 341m m3 {Gleam the Linsgzx“ and Wt: wéfi mafia: yea} progress.” 3 fimificd mnfidcntéy. Maxims Stillgf glad to dc; thy same. “But whai are the exact odds: 50:” 2*; ram mission?” Peter Wi’iyiami asked. “1 111mm, how many patients Bag Maxie in mission 21:185. 212:1“ how Eong, {in average F” Maudm iookec} :1: him simzpiy “Dr. Graepman said $1111! than: is ever}! reaswn to {kink 1?} go Ema mmigsian,“ she said. “\Vhat more do we need to knew Row?" She turned to me, her 51cc {iii} of uncertainty This: was; a cmciai augment in (31:: is? tcrvicw. There were several ways {ha}: I couid amwcr Fercr’s {glaring I muid give the bald S?;t€i$§fi€$“""thil{ man: than fifiy per cm: of {930916 with can“? like .z‘viaxinc's die wizhin Wm yearswcfir I maid gm: it mere gendy, :mci my than she had a chance, if :5 3m»: one, {3f annivng for mom thin: twc: years. E aim-Id cvm say, saégrzewimt vagaciy. aim? §§§€ WM young ans? Wang and had as gaan a {Swim as anyonz: 0f sumivizlg, on {he princkgéie that Shit wank} benefit mere from mmmagemcm man {mm smtis— tics. As 1 Eeoksad a: Maxine, E sensed rhar 3% preferred neither the Extreme: of ig— norem Ct: mar {he «extreme of mammarng demii but gamma: middic: gmufié. “Statistics ciam’t 39.}? angihixg; about my particuiar indivédzm. cmiy mm}: groupsst said. “Than: can b4: wida: vazi~ ability in the behav‘mr of any CZIIK‘GF in each pfii'SOil, bacazasc each 0? as is (ii?pr math—difi‘cmm gamtii’ally, flaring is 21 (iii; {cram emironmmtwazzd we mctg‘mfize the treatmefits difitmmi}: “'1 want my patimm to h: izszn‘ncdff said, izmking new at: Peter. “When Mm:- 3236 said 3hr undersmad Satire is 21 V61}? gefld chance (if mméezsian, {33:11 is 1ch mm. i 1’ mum 1:151“ mumhg 03: é: wifiai km“ year; Putting praise numbci‘és aim it at {hint p838? dacsn‘t mafiy {:11} as. 3.233%}:ng mm: 3130:}; Mama. In the Humming. WC um} 50 phm fix the has: while ac- kmwh-zdgfing the WW‘SE.” Onwlogiszs give bad news :0 pafimts some thirty»?va {Emits per mom}: an awmgc, telling patient thin" he has cancer, that his {Lamar has cannei‘zack, {hat his mzarmcm ins téikd, that no 5111'“ the: tz'catnmm “maid be i':ulpfi1§.And yet there is an agrecmcni muong Specialists sham how {<2 dciévm‘ such Harms. Man: than flurry per (“mm of enmiogists withw hoid a pregmvsis from a pagims if he or She does m): ask for 2? 02’ if? {he fiam‘fly raw Quasar; 51:53.: the palm: mt be mid. A simfifir {number speak in euphemisms. skirting the: mzth. 'Ebdaj, £9. most of Eu~ "i'Hi: NEW? YORKEK (I’CKJBER 28. 2002 {33 NEW yam TIMES B ESTS ELLE R 2% W9M§¥~$ YELL THE ‘ffifij‘i’fi £803? EEX* S§i¥?i§£§fis Wfififié, $6?H£RH€}¢$, A2“) fi’EAfiREAGE 'fhemseives inthese stories...and occasionaiiy, they’li iaugh out ma. {This beak] deserves a place i, an your nightstand.” --- fig}? Wagigega’ “ ‘2' “The great thing about [the beak] is knawing haw many of us are out there. ” ~— éi {be flprah fifagazma (k W§UJAM MQRRO‘N ;' An {95mm of H3. rC‘nllmsyus'gzrins . , 5‘ warm-hm}!cranfiiusucum {3N SAiE WHER'EVEF! BUOKS ARE SIRE} 64 THE NEW mama. OCTOBER 28. 2002 § rope (icmmm efzm d0 not 32%} pfiticmfi that the}! are dying Untii recentiy, many doctors mfi‘iy informeé that: park-3mg: that than: was; wthii‘ig to be done 15%)! than; com’mv " {zonal wisdam had it that patients ought _ m b6 spamd the anguish of hmwing thaa {he}; were geng to die. The m» f smwned physician Sir W’ilfiam 033381“. wiw, at the mm of :he last await}; wrote tile semimé {exzbmkwfiie Pfiflfi" 5 3 3:11:33 and Pmctfice of R’Eedicine,” empha» sized Kin: importance cf kmping the pa- ‘ Idem: ogfimigtlc. “It: wasn’t {he sarylc m be specific,” Dr. Bm’id Goiée, a formcr physician-in-chiaf at: Mmmaria} Sloan» Kemring Cancer CCflféfii‘, said (a? his medical amazing. which began in 3,952. I “The paticfit’fi agzgest‘inns am? fix: dos:— tor’s answez‘wmboth avoided detail Ami doctors; 116%? volunteer to give mom infomation. Of course, there were 120 formalized cadmofniife direci'iwé. Tim doc‘mr’s dug; to ease: the pmh was un- _ E awaken.” Wham § asked him "what he ' mean: by nor being specific, 31:: fizlki, WT'hri: doctor twuit’i 3:1}: ‘Yca, you him: a '- swims disease.” In 19:59, 3 E3001: staked “Os: {hath and Dying,” in}? Elisabcti“: Kfibier-RQH, i which 3am: bemmc. a bestfiefier, made ' ($321th an accepmble subjccf far discussion betwcrm gamma; and (Eamon: fix this firm ‘ time. in the ainerccn-eighzées. mimm} and political char] i3“: America—~somc precipitated by AiEJs—wimmduccd the mafia: that a patient imi a rigin :2) 3mm»: €V€I§1§iiflg his ($0:th Eimzw. 153 I993, Sherwifi Niziimd‘s beak? km- “35 [Ea-:3” which won. {116: Nationai Bonk AW *1}, eicscrihed in demii the gsythaiogy mad physioiu fy {3f cicada As mediczfi pmcfice grmvse mom so- phistimmé mart: pmpic m: fixing Imngsr wirh the knowécégt: that they may be thing. Qacisions manic in the: km: Smgtt‘n‘ of $311953 are increasingly cm 32:33:39: of. mamam. {hing rcquim’s cmmjemé and physical stamina {mm the individua} and his fwnfiy. Ami the défficukg :3? negoréw (King :15 this an efi‘ect on 60mm; as weli as patients. A mam: zmicic mpvrtmé tha: more than haif of the onwlggiste iriterviewcd Say that Erha- fmxgucm wit» messing of écath leads :0 an immvheim- ing wuss 0‘? fafiguc and filtiléty: the pro” {6553011 has {me {If t‘he higimst bumou: rates: in meciicinc. Despite this. during my nine: wars 0? maiémé SCI-“M21 and yrofcssimai miming in ms: ninctcm—savemim, lwas news“ in” smzcmé in he“: to speak about dying to a gmreiy iii patient and the gatient‘s famii}: l? was; prammmi that, as, medicai stu— éemtss, we: ltfll‘fifid how :0 dcfive: bad nears than-ugh cnmfifl absermtim of our mgmom, just 2 <; Wt lgmxed how to 15mm a deep aiascess by “meixmg docmys and men {Tying it ourseims. But 1mm gyhyziiw aims pmfémd to speak to their patients in. pzéxme. A36 the mbjem was new; miseé in our Ciassmoma 535 :m rmcoiogy fellow, I began my career believing that it was esscmial to pt‘médc dcmfisz it: my patients. Sharéng fizflifitia‘s seemec'é like the obvimss thing m dc»; sureiy a paritm 321013311 have: accees to cwrything i knew. Early 0m '1 had a case smzmwimr similar to Maine'st Ciath Aiken was a small, strauwhzzimd librarian in her farms with Emma cancer; sin: was man'itd, with two young Children, Like Maxine, she Ema? mzfitipie metastases to ban: and fiver. \ch mat in mj clinic of- 503, and aim: imifizd at me axpcazmdy “flake, with this: diseass, a mmissicm “amid (traiinaréiy has: three to six menthst,” 1 mid her biumfiy. “A pawn could Expect" to Stiwivc behveen 0m: :0 mo years.” She zipgmamd :0 take the flaws and“ wardy, but } lam: ieamcti firfim be: hus— Emnci tha? she Mei heft the appfinmmm decpfiy 3112114211. She mid he: chiiciren that fix: had Ugly one Christmas icfi. Her Face wm‘s {L111 cf despair whenever I saw» her. And yet C2213“: Efivcsi Ear neariy {our years. 8% “as, 31332 {a mare}, work para: {mm 3613 {aka can: {7f hm“ mfidrm, 3m: was una’mc {‘0 am}; thinking :hm $226 maid éic a: my mommt. Chm-{99%, I triad a iiif'fcrcm ap— pmach Manx}; Goiri a Sheri-9:46: tuck in his sixficg, Enid acute Icalicmia that has? regiszcd all greatment. At me 5mm, he askad me \fi’hfit cit-36 maid be done. 71 5225525er him that than: were 6mg; than hm? hm yes; beau tried, even thnugh 3 km“. 7 they were unfikeiy t0 hcfipl W’hcn Ham'y starteri m kitted amtmd hés lungs, 'I, had {kc Enmms; mm the hemorrhage with chest wives; 1 insismd that be fit mmbateai ssppoflec} on a rcspimmr in {ht I..C.U.,_ amd givcin Buan-EE'QUS Eficmd mmsfizsimm His hum: cicvcéaped a dam.“ germs m'iaythmia, so i gave (mlch for cat'diac mcdicarions and eimttmshock, I never askcé Hemy whm he wamed. HE: stayed alive E31” more than :1 were}; on the rcspir:tt<.>r, a (admirer in his beam, tubes in. his rhmat, unable m speak to {3221335 and éériemég wha 513C; cums: 50 his hcdséde. On 2: {thifiy {naming sax/:7) my; after 0112‘ 5.55;: meeting, Pvtaxiazce mtxzrmsd [:0 {he dink: i2); her first! mund :3? Che“ mmhcmpy. She had insim‘eni 0;}; coming 33mm; peter “(Mai pick §a€r up 21:” mp ward. Thf: chematizempy suite is a huge, (spam spam :ha: hohis {want}- 9: so par ticnzs racking inmwemms dmgs“, same behind a,”§i3'i'fli.fl$, when; mikémg or match» ing EQEEX’iSiOn. f‘vfaxim‘ hmketi at tize paw zicms she passad. MUSE west? weth hate: as kaml'xiefs t0 cover zizeéf Mid heads. Several mdéncd in rficir chairs. ihén :m5 925:, mm weak (0 sir up» It was 551%! Sm: mme 0‘? than wmfia'i Soon die. A Mi? 310m“ after Maxim’s chemo" {hemp}: Imminent, Peter mil had. amt a2." révmi. Maine’s ccfi gfimm mag. “He’s fled up? she mphimci to me, ami wa ar- rangcé for 1-: car smice {O 1;ch her. home. “I1me .3 called R’izmém hum that cwng m sea haw she wag doing. Peter an“ fizwttmd thc phugm mai mid 1m: that she was siecpiug. “She‘s going {0 die, isn‘t: shiz?” he said Hi: mphfincd €113: he had been seem}? kg; {ha ilxtcrnci, 35d Enid read that is C3593 like fi’laxim‘a paficnts survivcé 0212. average eighteen months, and {hm (i remission Easmii three in six {11.011th at been. “Pctcr, as 1 said wbm m3 11]Ct,.si'filii§~ tics dam} Edi yam Mm? is; goigzgz m 1121;3— pen {a any one gmfix)n.jiisr grassy.“ E go: of? the 93mm as quickiy as E maid: 333cm maid be no “Mei: manna-I” {fiswasivna thh fi'ietzds or fizmiiy; if. Maxim": had mmmd to, she could have 30;;ng on m the hittl’lit‘l. Over the. next seven mzmths‘ 1hr: metastasc< in Maxim‘s homes and in he; iévcr Lieczcasged Signéfimmiy. Alfimiigfi she was fi'eqaentiy tired and East he: hair, shat was 21131:: t4.) work part dine, mé even took a weekené trig) t0 Manhan with her parents and want to Newyort far a frienci’s maddizzg‘fimua an a maniac visit at the {11181 0f May, afmz her eighth month a)? {Realm-,1 zwticcd that one of her eyes wandereé, azzé She seemsé m. be tElfing hit? head to the right; “An: yvu having an}; Ecuhlc seeing?” Ska. Said that: smmcfimes it was: diffi“ CUE? t0 Emmi “Any duubic vision?” Yes, she mid, on a few occasicms that mack, wizcm she was walkifig dawn 312125;. 31631161216212" of the eye& is: cgmmflled $3}? a 331' (if cranial ncn’cs at the base (if rim Skull fin initial $112} scar: of the brain Liid not tum up anyfliing abmwr mai, hut 5mm: d0 not aimafy's defect 9111:3311 dcpt‘mits an the mania? nerves. 1 {33¢ plaizwd that 2: spinal mp was the has? way :9 cictcrmim: if the «smear had spam? 1:0 the brain; it weak}: 3U 0w us to HE‘ER{mlfifimfiiiifillifiiHfifiéifiiiEflifififimfiii3%;KKKEfiflififillfififfifiéfifllfifiifiiflfitfii: ' “ME; W5 'fi‘. m MW I I m I m 3% I” 'mulm -_ I?“ “quan huh. 1]..- Ifzt‘haf’s happening as yaw pw’tfalia seems {£5ch a. crime. same of the world’s gtmwsi slczm’m may have what if zakes to {trad}: the arse. fiesfseiling author Rova Hagstmm mvszs how Sherlock Hufmcs, (LL Argus: Dupbf, am} Parkar Brown can aim you {n m swan“ investing. Mm‘o business éflfvliiggfmie .2! a‘tc’xm‘ar‘um (a; rimxcnflamzrk Clueless? é m. .37 HI ifif TEXERE IHE NEW? mfifififih OCTOBER 2a. 2002 (35 (343 What it meant in the beginning. What it means Beautiful anti eve native , T359 Foam}: Commandment 5 is nothing short 0? a revelation. Francine Kiagsbmn, a mlmrmia: {0r "Haejewiskr Ewes? and Moment magzuine. draws 01'; {he Bible, ‘f‘alnmcfi, and Kabbamh. wcli 21:; {:nmmmtarima and Eagerkdfi, u.) expiurc {hit rich hismr'y, true «origin, am: timcfess purpose of this, mmersumc: ()fjcwish life. CrownPabiishingmm Wherever backs are said THE NW' YORKER, ()CFOB‘EK 28, 2002 wafeh f0: mum: mils in {he spimfi fluié. Maxim Lay on he; sifia as; a mezfiw cai residcm pafimned the pmcccium.1 tricci m diatmct her. W‘e talked about ‘ the Rafi Sam w‘m had smrtcci : c seasori ‘ strofig,mdwherh€r,gs mlmlvtheywoufci emfi up losing gmnes in the hamememh. Mm" steriiizing arid anesthetizing fine : ares {acmecn the {buff}: and fifth lumbar veraebme, flax: mskiem passeei a fim’: tromr km; the spinal cami, Maxim-1 twitcheé. ; Drop; (35 fiuié fail ii“an the {wear into ‘ a {83% rubs that he. had under it. New ma§ spinal fluid is clear; Maxim’s was 1' doufiy. “It’s war,“ I <said. “Stay dawn for an how; so you don’t gas a hagdachc.“ 3hr: askxzd what it meant" if {he came: had gem 1x: he: cmnéaé narvcg. I was $311051" certain, based on tha: clmldiness mi" the spinal fluid, {hat this 1 was the How much did Maxim:- want to knmv?‘ “It is; a major setback”? said. “I‘m not aural want to 352%; how iong E :1 mméss'ma i338 if {he cancer is in my I mainfshe mini “3m you SiEI‘C you want :0 talk abnm ‘- this new?” l‘v‘iaxiuc dosed her cycg: am? nodded. “P1301316 usual}: Iifi'c swam] weeks :0 I a few mamhs without an}? treatmemfi said. “But that: represents {hit avamgc. The m an: yeapfie who Eve image}: Twat" : _ meat with mdiatitm and chcmmfiempy instéficd in“; she spina} fluid may or may not emcmi fife, bu: it can reduce some af _ the. must :mmying (zompficatifing‘ like: ' i 1%: (inublwxisécmf Maxim: WKS siicnt. “is it ever; ‘i’fiéfiifi‘: being treatezi?" she: finally a 51:651. “Yam are {he only one whg can answer : aha: questian ,"1 said. “if? we dark meat it, it wéll quicki}: sps'cad to ether cranjai nerves anti pans of aha main and spimi mré. The qfiflit}! of you: We wouid be ‘ markeély impaired. 1 want to hcip sug- mén a}: much quality of life far as 30113; as possibit‘.” Maka upencd her cysa “I don‘t warm to dée," she said, bat— ‘ ginnifig to sub. “E dicks} {him}: it would happen so fast, so 3mm Tm not mady to die.” “I don’t want :9 Eoge yen,“ i said. Thaw was nmfning mom I cmdfi new that mum heigm “Let’s gm 5mg} by stag}, and Eafik aficr 211:: resuirs from {he spinal mp." Later aha day, I went: {'0 the paréaoiog}: iafmmtory. Under tide. micmficape. min mamas iarge «:35, with (135%me mtcfleia fifigd what should have been an empty £33m. “Carcinoma,” the pathologist said. vet the next Few weaks, We: bcgm mv diation treatment 2316 a new mund {of chemotherapy, infimé into her spinal fluid. A: firs-i, Maxim’s (iambic visios: imgroved. But afttszr three “flecks or $0 she fbund {inst she coulda’t' move her icft eyes, and we gut a pawl"; over it. Shard}; themaficr, {he heft side of her face m dmop. A SfiCOfid MR3 Silmwed dam the cancer had spmad to the mcmbmgcs fining the gamma} cortex and spinal card. it was. cvtnimg when I came inm Max-- isze’s hospital «mm. She was; watching I'eiwision, She turned to me, as I switchmi Off the TV. “Paints: left me.” 1 noddcxi. wing thaw I had noticed that he WAS not amund the paw few days, “He‘s bares; stat:ng 5011339223 else the pass zhrcc momha” I remained Silcm. “I gimme fair, (imp inside, that he was weak.“ Maxine 12333366. "No, mat just weak. He‘s a schmfick. A real schnmcic" “Do you whas that wozd fines,“ 9313; means in Yéédish?" I 31mins laughal I Teak her hand. Shy: tried {'0 {1113335 back but hag} Emit force. The germs from the cervicai spizaai cord were being mmpressad by the daposéts a)? gzmmr. “I’m mt sum how much xrngch E hgve Eefi.” Evinxitze gnici. 3m: was in :2 fiagiic: madman. It waS time to clinicai issues» “Re-member once I asiwd you Whit? your wishes were if we rcztchai :: point" whea further therapy wmfid n0? improve the quaiity of yam fife?” Wham noddcci. “So :mu think ifs gust a few day?“ she: asked. Her voice wms hollow. “Pmbabiy more rhzmjusr a few days," i said. “Prnhahiy \‘vaC‘iCR-s. Cir lnayix: inngnw he been wreng Eacf‘om” “Ami flaming can be: dons?" like $1 pagémts, Maxine was finding 1% ainmst impassibic to giva up hopc. “Nothing that E know 0?,“ I said. “Ami to mnaimse so give you chemo- therapy wouid no: improve the firm: we: have left. But anythiag 1221:“; (£0 £0 make the time shat we, have letlt gonad for you, Hi do." Maxine turned away. “How do I. ac— rzmfl}: 635 {mm the smear?" “You i056 musciousimss, g0 mm a coma, and citfiei you Stop breathng or your heart maps. Bur: yau're not awm: of my 0f it." She was sflem as Y gar holding her hzizéd he first rime I witnessed death was in my second yea; 0f nwdimi Schmfl. My fazhar had had a massive, unzzxpccteci heart anemic, am} 1 weak: {0 meet my mother at Elm lmspiml in (330mg, The sheets were dmnchazd with sweat. His eyes were fiimy and repeat“ cdly mum“: uywagd. Cmrse, gmnzing noises puncmamé his firearhing, and his chest heaved. His iim‘m firked wiidiyz This went can for Henri}! half an hour, as a laygc CIDER on tht: waf} tickflé off the Ellif‘iutfifi. Tth 215%; :1 km cemvuision, a pink {rm paureci from his ruputh, his head snagpeci back, tht fizzle color rt:— mainng in his skin dreamed away, and Ex: was stifl. I; 1131:} my mother, mm?) with dis" bcfief. The (beta: on call, whom we: did not know and who had amod in}! 3;: we watched, Closed the Curtain firmmd flu: bed. Ht: looked at me homing my mama-r, and said weak-3y, “it’s mug}, km.” 7 ' Altiwugh i Eater Earned aha: the $2133- ing movements of my father’s fimbs were the resmEt 9f szeuromgicai rafl.¢xcs, 213d that he had not harm cozxscéous, I could not stop \mndsfing if has had sufw Ferd. The ugiinestg of them fimfi min- utes often. invades otherwise cozn-fiyrting mcmarics of times we spam teagathar. When i became a physician, I. vmwd then: I wmzld do everything 3 could to temper such gruesome aperiencas for the patient and for the family. Daring the Middle Ages and {he Rn:— zgfigssamze, {13215:} was supposed {0 be met with words of welcomev This; was {he core of a?! fimrz‘mdé—jthc art of Iiying.” The “arr” prcparcé and purified the 902% 5:31: by Einkéng his expericnm t0 Jesus? death on the (1:033. Treatises like Wile Eémn Cmmm’s, printai in 1491, mstmsztcd iaymcn m th'mk about the and 9f life, even when they were hcalfhfi and die? {sited What; wm‘ds they shouid cxpecr m hear msz saywhen dcmrh was max: “This {$2113 of your damning shali hc better m you 6121:: the time :3? 3/611; birth, for now all sickness? macaw, mad mmbla $13331 Liam part fiom you forever. ’Ificrefom be um aggrieved wéth your sisknass and take it 110?. with grurihing iaut take it: mfl’mr 311 by giadness J” Twin}; the physician fi'equemly finds fiimself aasuming a raft: that “um; 0392 Elm exclusive province of religmus au— thorégicg. Yet the palliative care he. affm is psiamdl}: meant to ease physical suf- fer fig; he is mt {minad to aflafiatc may 601ml pain. In mcéiczl tcmns, a "gooé death” is a cieath with the. 131st physi— cai angering pmsible. As we; marieme’i suggests, though, there is a izisroriczfl mo— tion of a “gooci death” that is. mom com— piicated; is is as much abaut a mlfiwmf 1363’: 31110“! 'huming (it trapping :32; 75mm ‘ a SW“ 379:1!“ 1m}. nature geniem ami miiifiifé 139nm smart gnmps that mfiflrsa hunfifiga ' trapgfgag, anti lagging, I Swath: Earth. Bim’t furniture at made {fun}: names! armada gggwéi ‘Wfifinhfiswfi 'LDLIFE .'Tll£ “K'MANE I $003529 AVE 0 EWW*W§VJ;w~*HWH” HUUIETY . I LANE TRUSI OF THE l'Ni’S'EB STATES ww. {-221 t. o rg '1' THE “'iUHjH‘. LAN?) TIN HT. “1: hcip \x'iicf animals by purmmu‘ni‘iy g'rrntL-uiimj {heir mum”? inlhituib. 1‘“ find nut muru. nr if you Imu- Enml 31m mm: In prcncz'w m. a {mu sanctuary fur wildlife. uni! 1:24 Hi‘ r3531 nur “'chhi'fi.‘ at L~;;‘-L'.:;'i'!.utj.g. (fnmnutinfi 115. “iii inku 1m: :1 Miami-gm Fur \rikiiifu. (El-c :‘mulh amid Ens: fm'm‘cr. THE NEW ‘s‘Ofifile’x, OCTOBER 28. 2002 5? {18 Give Your Childhood Another Read : L the ficsmefling author of flier 31329 of 19:03: comes another vi'viércimerpmmrim off: fiafldhwé classic: The Hardy Boys. EMIon has reshaped the 1927 verséen of Wm Hausa {m fine Cfiginro a mystery for tame-rs of ail ages, fmm those who: have yet to meet Frank anal Joe Hardy to i those who grew up alongside Chem. FEATURN; A mmmowz (11311»; {ZASE um: mm smwmc AND A SI:ECLI\1..m-*§~<:omkmm’5 ST. HART N'S MINUIAUR www.minataurhooks.cam E‘HE. NEW YOMEER. OCE'OHELfi 28, 2002 attide {award luving fife as it is abotit a the physical 1113115 {here mom, than, that i physicmm should do to maka‘ dying in - a lmspital after fitness less emetioaally taxing? I as: jammry, (me of {he first acw demic sand-16:5 of how cfiécriveiyon— - i (it‘21xt‘sgists communicate, critéaiaiinformaw ‘ den :0 their patiems wm publish-:6. A i humimd and Sigrth patients caved for 3 by nine: oncoiogésts garticipamd in 531:: L research. The doctor—paricnt interim“ ' L {gong were recorded or; swim-49¢ The study fried to detgrzniize E‘WO things: whather the infomatioa dimmed to the, patimts was sufficient f0: them to make an informed deciaim‘; about fuz‘thcr treatments, and whether the docmr an" managed the 935531155 participation in cimosing among t'mmnents. ‘ :Mthough the oncobgists knew that 3 they Wtth bcizzg tapcd, in more than :3. quarte; 0f the consultations the patients wen: rm: mki that {hair dismay: was inw - ; wmifle; a simiiar pcgfcemage were not ' = inébgrmcd of thc Skin: directs associated - with [his gmposefi amincmcer therapy, ‘ Oxfly five paticnts of the hmdxed and: % eighteenflome Four per can Wreceiveé wiaar €316 mseafihcr‘s cansidemé afie— quate infvmatian. Ia maxi}? ninety per cent of the tapad discussions, this 0116:35- ogisis faik‘d to ask aha patit‘fits if they andszstood the informaéim biting pre- satxted to them. Thaw results are in keeping with prior research indicaiing that more than :1 third of patients: with incumbifi metastatic cancm’ beficvc that {he treatment offami by {heir doctors WEB acmafiy cure them. Suffering is; not the only 03%. Many in the mcdieai professitm have specu- inmd trim: docmrs’ uncertainty in gliding patients though the and of Life is one. of aha primary causes of rising Width-care mars, Mom money is spent 011mm dur- ing the last weeks (3%" fife than on the months or years of can: (ha? precede: it". Thft kinds of éntewamioim that am mu— téne in an iatensivc—care uflimnunps r0 3115mm cia'cufation, respimmrs to venti— §are the 1ung5~cos§ hundmis of thou— sanés of dollam. Semi: physicians (Emit: want :0 acknmiviedge that a paéwt is; going to dié, and regularly {fifdtii‘ tats and presccdurcs :1: a point whcfi no 7613* gambit: gain can «some. of them. firm? "ms Show {hat a doctor doeg not shorten the life 9f the pasien: when he chewes “mer it (1150::ij 315912 #2121263 féc’fldémlgawmmmt want to pfmemfeyou Z9 {liqfidfm‘f extant gfiffic law?” to pmvide pafijatévc rather than immm Siva cars. 5131:)? this is {men to change the par ibasion's appromfi m end-offlfiife cam. But change 11:13 been 519w in coming. “There is; ewry instituaionai 13mm to pafiia- tiw; care,” Dr. Kmhleen Falcy, a memo-n Oncnlogifit at Sioan—Kactm'iflg, toki ma. “Traditionally, oumlogists are paid to give {'3’} cmatherapjg no: to have kmg conversa— tions, In The fluffy nineteenmnineties, a mm View by the American Board of internal Madicifie of {mining of medical msidmts cxmchtdcd that chm: was 2:. very low level of campetenc}! in d&:1l§ng with these is" sues. And yet ths Naticmal Cancer Insti- tute has {men unresponsive to the issizc 0f" pammive care‘ Alikough 23in}! pm“ can? of Ameri-Gma w 0 1mm- cancer wit}. die from it, {he Natinn 3,1 CHHCfi' Eastith 2:310:23ch 0113:}: one per cm: of Rs: budget for" new search anti mining in pafiiafive care. it’s not welcome {0 talk, about dying." Dr. Diana EVEBEM. the director of the Center m Aémnce Z’afliative Care at the M02111: 3m; School {)5 h-‘Ieéicine. En New ‘I’mk1 which is funded by the: R0?)- erflfl’oeé Johnson Foundaritm, has been working in instimtiomiim palliative can: finr Heady :1 ciecade. ‘Whm 1 calicé he: in her nfficcr. Eha {viii me that there are cur— rmtly seven smciias showing that patiiau tive can: saves money. “11% aiways bean the righr thing :0 5:0, 9:" marge," she said, refen‘éng to the imagmtim of pailiarivz cars into matmmt. But it was {ml}? afm; her foumizfijan and whats dcmonmramd :ha? patliafivc mm: saves money {hat hospizais anti iw surancc cotxuparzées began to instituginn- (dim: such policies. fiatméing m Meiscr, was} today what E'mppcns to people at {he cné of life has lass to dz) with their wishes than with the avaiiabie resourcfis of the pflr‘iiccdar hospi m1 anti how health care is fimded in this country. Mm}: has“ pitals don't have paliiative—care pm- gzmns, for fixampic, and 313 patients are often kept in an acut€~~carc awaiting anti} the and of their livasV The mozimtioa m cfiange medical practice is Emily in place. Is there actuafly a “best approach” to telling a gratith that the: and of her life is gear? In iVIarch, 1’7}? karma! QfVCe’ifif‘mi, 022623!ch publixhed several scenarios illustmting how a doctor might hazaéle: such a situation. T11132th Cit: makes; it clear that. until now the mcciical profession, which '13: built an the norm}; 9f imprm‘ing Mid rcfinifig is _ I Bestseller pramices, has; been painfilily inept in its sfibrts r0 impmw: prfliiative care. "Hm _ 3cm}sz ware bimed on a. mass simiiar to Maxim’s. A vmman {Rated fur breast 7 cancer that had spstad to bone and fiver now had mgmwth of the cancer. She was married, with two wung chiidmn, and _ her medka} record did flat contain an md—gf—life directive. SCENARIO ONE: MD {with umtsmf somizcmms}: Mrs. M, i dau‘r think there is anything mom: we can {In for you. 1 thin}: it“s film“ for has-17km MM. M goofing frightened}: What? Ym: meat: :iwre‘s mashing c156? MD; i’m sorry. TE? rmwfagz‘s: {card’s 1' hr 713mm. .-n4uu,, _ (no; SC NARIO T\V('3-: _ MD: Mrs. M, mama. uhhh, haw are you ' feeliag? M RS. M {tentzztiwlgz after a pause}: Fr}: .1 hit i’lt‘fi‘é'f‘ rim: ink you MD Esgmking {gzaiviziy and zikcerfm’EyE: W63, i‘ifi‘ “kc :0 have the team that hips with mmfwrr mmc see you. 1-: that a}! fing ; MRS. M; Sum. if you mink They Cam help. MD: Great: I'Zi m” them to came by. ’IL’M 32%}‘sicmg {eaves 512:: room. J'fl/I/IJJJ A, 7 _ at”; céémm mm: uas GORE “was Not surPrisiflg'éE the article crigicims - mm w CON-‘50” m 5 W -' W .4"! m bnih approximath first for inland}; ‘ ‘ ‘ abancioning the parking, and the sccand ‘ fig?" ‘ , _ for skirting the mzth. Itgoes on m sug— : ‘ " ‘ " I’ :l " w.“ r n “‘4‘ gest that the physician choose a com— ;, IA ." ' A '8 forminla, private place, and the}: (7:31:33; an ideaiized scrEpt, En whiciz the dmmr ; mxmmlrims {he sématinn {“Thc calmer is ‘ gaming worse. . . .The scans sheweci the rumors én :ha: iiwr am bigger”) and asks . Mrs. M Whm: Shfi: Expects will happen: “A vivid-narrafiw-«m part histmy, part'txmiague— and mosfiy just great fun.” 4mm fingehs' Times Rani; Review MR5. M grbvugbefwi, and .2 bit {wry}: E \X’EH, I guess I'm goésg to (fig: 0? {his nag-1cm. I iSMrfmg so rr}! more? _ M D €93;ng quiwfga mores box of nswes . (£035? to patient): . . . Wha: have yen: been ‘ fixinking? ; MRS, M: We“, I‘d like it to im peaceful. i’d ‘ Mk: m éusr Fail asleep. AWE 1 want my hus- ' 3 hand :0 be abic m mm, mad in: my Cifiildxczs m grow up and remcmhcr ms. . . . Brigisrmi— ‘ ing a hm And I'd like w gr: :0 ms Vegas one § name time? Mi) iffizrgfiflngh it munch; like what ym: 5 are Saying Ls you wan: in make {ht most 01' ' the time dam is left. MRS“ M: That‘s right. mafabie, 7 i The: “successfifl.” dismssion from the mmoiogy journal minus" m the obvioas ? pmbhcm uf trjdng m miifirsuch pmaicc. E Pfixiay, afar! cariag for patients with ad« 3 waged waters for more than twang-five yew, I have raid maxi}; five handled pew Henry Bait and Compa )7 www.hcnryhuhrum wxnvixiue'iaEitudcs.cnm THE NEW YOKKEK OCKDDER 23. 2002 6‘) M 3::- a N % N t: a N E m a: a: H- m '1'”! a an: M l.-.I-l an. s: 3- "((3 109K WHO’S EWING 70 THE YALE $011801. 01‘- MRNAGEMEM: Rage: Ail-es FOX NEWS NEFWORK LLC Bennis Archer AMERICAN BAR ASSGCIAEiON Finland Betts CHELSEA PIERS L9. Pater Byabeckaletmathe NEST§£ SA. Ewald Kist ENG GROUP Shelly Lazarus {JGILW 8; MATHER WORLDWEDE Danish Maugham CmGROUP Indra Naoyi was: 50M '30 PEPSICO MAYBE YOU SHOULB BE HERE T90. Every year the worid's leaders 16m 400 of the brightest business students at the Yale Samoa! 0? Management to discuss the chalaenges and (immunities facing business amt saciety taéay. Be a part at K. "£09 taient.‘iop ieaders. Yo}: malty. intefiecmai excitement for a iiietime. www.mha.aie.eda fluentng Leadersfmfiusifiess amisde YHF YCXWETR, (KWURH‘. 28. 2002 pic 3*}: :1: rim}! were wing to dig; mmiy Em 3.!" and: a camwsaaéon gem: as simmeri‘dy Q; . the «tencézzsim been. as. tidy 21's thcjourmis modcri. Buz “Haw mi in)” sarnarias, film fix: first. five in the amide, 11123}; at 1:135: her}? pmrma the $513335 6th bimnécrfi image ; taxi}; in my career. Ami :hu mad}; showed, viewers can do mad) 3}} ' g ’ m inw sure ghan pauicmzz azzci zhcir ii‘amflics rm cciw: szdficifim Erifiamisiréon Y0 make. my ponisz dwésimm. \ka 19 MW Edam; dam: in idmfifi’ ‘ the key problems. In 1995, :h: 0pm 89" aim? .Izasfimm spamscsmé an initiative ; saificd the PIOjE‘CE (m {Death in fimcrica; Katfficeyz Rule}; the mmwencolngia: {mm Simryficttcring, in its L‘iércctm. “The purpese i3 {0 aducatc phygicizms, IRUSEQ, and 30:31} w<‘:r§.~:.crs who wifi pron Vida ifitaaiamhip in academic boss‘pimls,“ She mid mas. E's not cieuz wha: “is-ada— ship” means in this amicxt. 21:36 whats”; I 35de how affizgfivc Sfich mcasurcs were. she mid, “V‘v’b iumwtha: {ha current gm" 5 swim: docszz't know how is ($0 this wail. Eu: if fix: rah: nmdcls know it we ham fin“ 21 dm‘ninc (tfibcé {hat will make it <‘;1§-~ is: fw‘ the: next gmcmtian.” The Spam Swim}? imtémtc will haw: : Spéflit flaw/five mélfion doflars (m Cdil' ' cafima by the. and of mm" }-'e:xr, and tht: ‘ pailiathw~cam ccatcr suppmted E3}? {he Rubézrt thd Johnson FOLIIIdEHiUn, ' Whch Siam: Meier Winks, has spam 3. iziimimci 21: LL} fibfiy 111$an (EQELUE? on ad- vam‘img pzfifiiative {are am {he pus? div L‘adc. These cf‘fi‘n‘ts have mmircd in dumges w iiw yu‘a‘fibsgiam. Sim“:- zim Egan: :‘gérmzccn-méncdcsz. 55016:}: told. me, "the: As'a'acrécam Board of inwami :‘s’izxiicim has. required écfimnssfmrimz 0f 22 icwi a)?" compa‘tcrmj; in. pafimtivc care: am} symp- tazzr: managmncm." .5335 par? (3? medi“ cal flaming, an é“:th will. gr.) thmugh 1a scrip? with 21 resident wha mam (Em? unstmic his m: be? abfiiq {o guida [Em person through dacisiun~133a§céng-~such 2H coming {u am cndmof—Iifi: dircctivc and cozmng up with a. plan for pain unmagmncm. 3 After i miked with Maxine. { en‘- rzmgcd. {0: inc: :0 be {mmfcmd 1’0 3 ‘ Spccia} hospice unit, and $002"; aha hegém m drifs in and mm of canscigusrzesa. {be camscr gwessifigf 0?; the mania? nerwu cmmtcmd m the hack of he!” fim‘mr and him“ magma had. manic ét cfiffieaii’: f0: her {0 $s-vaiiow. 313:: nuzrscs had {G major: her 53.12% {*0 garc‘vcm has: {fem} choking. Six-owl}: befim: mm”: a weak Eater, E W25 paged and mid that E‘eimific‘s dead} 21p- pcmzd iimn‘ancm. Pv'iiixinfi’s parcgits wcrc sifting by hq‘r bed when "i came in. They fimoé up, and. 351m Bnflow hugged me, crying. 3V 1: Buriaw’s 1921a: was; frown wk]; grief. R/Iaxinc was no longer cogsciaus. Eva}? {cw sawmifi, hm“ chest heaved. and 323C gasped. She was tntfiz‘iflg what is atflled {ha agomil phascmfiaéxm {mm the Greek zzgm. which means szrugygicmma period {hat pmccdcs {ism}: ami cm Last {fiém a few mimircs 3:0 Maura. } warmczi §=Irtxin€§ panting {hat f‘fifig was: usuxfiy harrowing, and that SOYUE’ times féméh? membmfis praférreci rm. to x'vimcss ii. “I. want {0 he with my baby.” Max-$155 mathm‘ mini. Kim/(E3163 hands ixagan m twitch and he? Hawking: moved mm :1 Syncopamd pati'cm atz‘iiéazd Cimync—Smiies, a short set 0? macaw iég’cué'hs bmatkuting; a icmg Emma-e. EV] r5. {inflow miscd hat hum. “M mic. we love you, and God 30x13 mm." Bm’imv 5:21: straight. his: hands amped £11 2m 31;). Somedmefi a! patiem dies: there: it: n mmukiw hum a)?" masmlas' :zczivitjgg Eikg agrmdfimai gamma. I br‘di‘fld 5:in6}? far 3: when iii-8336:“; ‘fizzgesry‘ iatfgrm in mite?” M if 3321:: wm: grasping; For m in-* virsiiaic Ciijicfl. Thaw musdc Lxmrmczims {ayirinued {or 3mm: forty yrnérmttss. Tim“: :2 harsh nailing mum"; mm: ifeam Em: chest. E giamfiud :H (ha: muse. WEN} was; 3163i? in YEW mm'phin ‘ ' gamma ’Ifl‘htrs jurk a? Maxénc‘st 130d}; :1 Sharp arching of he; ghcst, {0% ism‘ud by a series :3)? fiuzrtréng mourn mama in {has musdcx of her neck. Th1: BMIUWS Emmi £2171 Maxine}; Skin was aireauiy changing to an asheu hue. E platcé my Si'm'h<.)sc<>pc {war her hears". “1 am awry.“ the “urge: said. 'i mac?ch (war am? £00k Mr. Barlow-"S hand, and {312311 mnmd :md mlbi‘acmi Mrs}. Barkiw 2-5:: 2411:: Cried. '} E6142 {he Barbara and want :0 the mamas” mam m fill out Maxim’s; death earfificam I (iesémumd {I‘m primary cause as respiratory failure due to mcmsmtic brunt cancer as: Em: hmin am} hanécd 2hr: chum M3?) the death :‘m‘tzificam to the {300: dark. Tim {£836 a? dam}: W333 12:57 PM. 0 2 was :2 sag—:18 cw six-«2. ...
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Dying Words - “Extramfinazyx - has; 3331 {fig pace:...

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