How much treatment for the older citizen confronted with a difficult illness?

Recently, a very dear 88 year old friend, whom I have known for 50 years, was diagnosed with cancer near his pancreas.  One option was to do nothing that would likely result in his death.  The second option, was a radical invasive surgery called “the Whipple Procedure” that required an eight hour operation.  On the web I read that the survival rate for this procedure was 25% for 5 years.

My friend was a healthy, lively, and creative man whom I cared for dearly.  When given the choice, he elected for surgery, in part, because he was curious to see what would happen and how he would do.  Obviously, he had an adventuresome spirit and often spoke with an awe about life.

I was pleased for him and his choice and hoped he would have a good recovery.  Unfortunately, it was not good and he died 14 months later after struggling with the many side effects of the surgery and a return of the cancer.

Although I supported my friend’s choice, I’m not sure that I would have taken that 25% risk.  The many side effects from surgery can be hard on our aging bodies and we don’t heal as quickly.  Complications such as strokes, infections, difficulty with digesting food, multiple medications can make life pretty miserable.  Instead of surgery I might choose Hospice with palliative care and make the most of the opportunity to spend time with my family and friends.  My choice rests on my desire to have death with dignity on my terms.

Hospice patients tend to live 25% longer, have a more pleasant end, and cost less in every way.  Families report that while there is grief (as there should be), it is not as deep or infused with complicated feelings about treatment choices.

Examples such as my friend’s help us decide what we would do in a similar situation.  Making a choice is good for us to do now while we have the capacity to make decisions for ourselves.   It also enables us to make our family aware of what we would want in case the decision is suddenly and unexpectedly thrust upon them to make in our behalf.  It can be as simple as saying, “Remember when Uncle John had that medical problem?  Here’s what I would want to happen if it were me.”.  If you engage in this conversation repeatedly, you inform your family and loved ones as to what you would choose.

And don’t forget:  you can always change your mind…no one needs to hold you to what you said.  Who knows – when I get to 88 maybe I’ll decide that the Whipple Procedure doesn’t look so bad.


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