Take Care of the Dying Stuff so You Can Focus on Living
October marked 8 years of my life living with stage 4 lung cancer. At stage 4 all treatment is intended to be palliative rather than curative. The goal of treatment is to give you Progression Free Survival with the best Quality of Life possible. At the time of my diagnosis, it was hoped that I might survive 10-15 months with the most aggressive treatment available. Of course, no one could predict that I would be an outlier on the face of the bell curve of cancer survival.
Lessons from caring for my parents
At the time I accepted the prognosis because they had been right about my parent's lung cancer deaths. Neither of them survived 6 months; my dad in 1968 with mesothelioma and my mom in 2006 with adenocarcinoma (the same type I have).
During the few short months my mom lived I learned quite a bit about preparing for the end of my life. Taking care of the business of dying is something we will all face eventually. With lung cancer, we learn to plan for the worst and hope for the best.
Planning for the worst
Families often avoid end-of-life discussions because it is an uncomfortable acknowledgment of the tenuous nature of life. Then something catastrophic happens and families are torn apart arguing about what they think their seriously ill or departed family member would want. Assigning a durable medical power of attorney or medical proxy is an important step. This is a legal document. The person you designate can begin making decisions when you choose to relinquish that power or when a doctor states you are not competent to make a decision or you are unconscious.
The person you designate should be fully informed as to what treatments you will and will not accept as part of your treatment or in the event of any other medical emergency that should arise. It’s best to put what heroic measures you will or will not want in writing. This is your Living Will or Advance Directive. It’s important that it be a Durable Power of Attorney or the powers will be revoked if you become unconscious and the doctor or hospital will make decisions for you.
Do Not Resuscitate (DNR)
If you chose choose not to have heroic measures used to prolong your life you should file a Do Not Resuscitate (DNR) with the hospital where you would ordinarily seek treatment. It’s a good idea to have a copy of it in hand at home in an easy spot to locate.
Television gives us a distorted vision of the outcomes surrounding CPR or cardiopulmonary resuscitation. We see people up and around the next day returning to normal activity. Reality is different. In reality, the patient probably experienced broken ribs, in some instances a punctured lung. There is no guarantee that the patient who has been revived will not experience brain damage. Damage can occur after 1 minute. After 5 minutes brain damage becomes serious, at 10 minutes brain cells are dying and damage is irreversible. They may be able to restart your heart but would you want to live if living would be in a vegetative state? Heroic measures include: restarting your heart, connecting you to a machine that breathes for you, feeding tubes for food and liquids or any surgery a medical team seems necessary to keep you alive; even if you are not likely to ever breathe on your own again or you become brain dead.
Financial durable power of attorney
Legal title will vary by state. Bills and financial obligations don’t stop because you have cancer. Designate someone you trust with this responsibility. They can make payments on your behalf, receive payments to you, manage your assets, and pay your taxes. You may specify or limit the accounts that this person will have access to in your document. Again, it must contain the word Durable or their powers are revoked when you become unconscious.
Very little can tear a family apart faster than an argument over the planning of a funeral. You need to communicate with your family exactly what you want. I am a single person with no children and I didn’t want my siblings to be faced with the decisions that come with planning my funeral. No one will be pressuring my family in order to up-sell them on an expensive casket or urn.
To start the process I contacted the director of the funeral home I wanted to use. Cremation is my choice and I have talked to my family about where I want my ashes spread. We made arrangements for everything from the actual cremation to the memorial card. I’ve selected the music I want, the Scripture, and poetry I want to share. I’ve even preselected and paid for the flowers.
Pre-planning meant pre-payment which can be made convenient. There are insurance companies that will set up a payment plan so you can work it into your budget. The money goes into an escrow account and the funeral home receives only a small stipend for being the middle man. You are under no obligation to use them for the service.
Focus on living
One of the greatest fears surrounding my cancer diagnosis was the burdens caregiving would place on my family. Following my mom’s example, I took charge of the items that would cause the most arguments and the tough decisions and had them all down in writing. With a cancer diagnosis, we give up much of the control over our lives. When I had finished taking care of all the dying stuff I felt that I had taken back control. It also felt as if a tremendous weight had been lifted off my shoulders.
With the dying stuff behind me, I could focus all my energies on the business of living.
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