May 13, 2014

That Good Night (Memoirs of a Cancer Nurse)

Do Not Go Gentle Into that Good Night
Dylan Thomas

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieve it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

I remember this little poem from one of my high school English classes.  It is Dylan Thomas's most famous poem, written for his dying father. 
For some reason I've always loved this poem and the passion the author displays for the importance of fighting for life until the very end.
Yes!  Life is precious and we should fight for it tooth and nail.  Never give up, never! 
And this is the attitude I adopted and brought with me as a nurse to P-12 at MD Anderson. 
I cheered on my patients as they fought cancer with all their energy and being, as they fought to live to raise their families and return to full health.  
I felt like a cheerleader, silently (sometimes not silently) encouraging my patients to fight, fight, fight!! 
We will find a cure and it is never too late! 
Rage, rage against the dying of the light! 
Do not go gentle into that good night! 

Though I still believe life is worth fighting for,
though I still have hope of finding a cure for cancer,
my attitude has changed somewhat
as I have realized that perhaps sometimes there is nothing wrong with going gentle into "that good night" and realizing that there are better things to fight for than life......

Mr. K was one of our floor's "regulars" at MD Anderson Cancer Center.  He had been coming to our floor for treatments for several years before I started working there.  He was the most pleasant man with a great sense of humor and his wife was equally as pleasant.  He was in his early 50's and still appeared to be the picture of perfect health.  He just had a pesky tumor in his liver that did not respond very well to treatment.  The nurses on our floor loved him and had become close to him throughout the years.  
I happened to be Mr. K's nurse on his very last day at MD Anderson.  He had exhausted all treatment options and was now in the end stages of liver failure.  He still felt fine and looked great despite the fact that his skin was so bright yellowish-orange from jaundice that merely rubbing an alcohol wipe across his skin turned the wipe yellow-orange.  He joked that he was the all-natural oompa-loompa.  Knowing that there were no real treatment options left and not wanting to subject himself to further chemo, he chose to begin hospice care at home and live out his life while he still felt well.  Though I was discharging him to go home on hospice that afternoon, his spirits remained high, he read the morning paper and ate breakfast with his wife, and he seemed as content as if he were on a tropical, relaxing vacation without a care in the world.  
Sending Mr. K home for the last time and knowing that we would no longer see him again in this life was difficult for my nursing buddies and for all the staff on the floor.  There were a lot of tearful visits and goodbyes in his room that day, and ironically he was the one comforting all the nurses and CNA's.  "I'm just graduating onto another grand adventure" he smiled.  
Finally at 3pm he asked where our nurse practitioner, Shobha, was.  She was supposed to discharge him early that afternoon, but had been avoiding it because she dreaded having to say goodbye. 
I paged Shobha and she finally came up to the floor.  "I'm not looking forward to this," she said as we walked towards Mr. K's room.  Shobha and Mr. K hugged, chatted for a bit, explained some of the particulars of getting set up with hospice and making sure he had all his prescriptions, and then Mr. K looked at Shobha and said, "Okay, Shobha, so tell me what I should expect over the next few weeks.  How is this all going to go down?" 
"Well," Shobha started, "as your liver continues to fail, you will get more and more tired.  With liver enzymes that high in your blood stream, your brain will slowly begin to shut down.  You will sleep a lot more often during the day until finally, you will probably be sleeping most all the time. just won't wake up.......and you will most likely peacefully and painlessly pass away in your sleep."  She said it most matter-of-factly, but struggled to contain her emotions as she explained it to him.
"Well, that doesn't sound too bad, does it honey?!" he turned to his wife who just smiled at him through tears.  "So it'll just be like going to sleep."
"Most likely," Shobha said. 
"Well, that's the best news I've heard in a long time.  Look, don't worry about me and don't be sad.  It was a great adventure, life.  And now it's time for the next one."  He and Shobha embraced again, discharge papers were signed, copied, and Mr. K walked tall and with a spring in his step as he left our floor for the last time.   He was one of our patients who passed away on my birthday several weeks later, and he passed gently and peacefully in his sleep without struggle or pain....
***** Not long before sending Mr, K home on hospice, I had the privilege of caring for Mrs. D on our floor, a lady in her mid-40's, a mother to two teenagers, and a victim of pancreatic cancer.  She had been to our floor numerous times for treatments and for symptom and pain management.  This time her symptoms, pain, and blood levels were all over the place.  She was so sick that she was unable to go through with her scheduled chemotherapy regimen until she stabilized and recovered.  Chemotherapy takes a horrendous toll on the body and if one is already frail and ill, the chemotherapy could actually be lethal.  Chemotherapy is strange that way in that you hope for it to poison and kill the cancer before it poisons and kills you.....So Mrs. D remained hospitalized and on our floor for a few weeks in hopes that we would be able to help nurse her back to health and strength enough to withstand more chemotherapy.  However, her condition just kept getting worse.  Her abdomen was filled with tumors and fluid and she looked like she was 7 months pregnant.  Her pain was rarely under good control and she was often delirious and rarely very lucid.  Her mother rarely left her side and was the perfect cheerleader, encouraging her on to "fight for your children, hon!  We just need those blood levels to go up a little more and for those fevers to go away and we can start you on the chemo. again!  You're doing great, hon!  You can do this, sweetheart!  Keep on fighting!  That's my girl!"
After a few weeks it became apparent to the staff that Mrs. D probably would not recover from this and would probably not even become well enough again to return home on hospice.  Even after the doctors had conferenced with Mrs. D's husband and mother, her mother refused to give up, and would stroke her daughter's hair while she slept and whisper in her ear, "Keep fighting, honey.  Your kids need you."  And fight she did.  For several more weeks I came to work every day expecting to hear of Mrs. D's passing, but she was always still there, still refusing to "go gently into that good night" and ever "raging against the dying of the light".  It is amazing how much a person can live through when they have a strong will to live.  I became quite close to her mother and her mother had told me in the hallway one day that she knew things were not looking good for her daughter.  She knew that she was dying.  She knew it was coming soon and now what pained her the most was that her daughter wouldn't let go and continued to suffer greatly.  "I just want this all to be over," she cried and hugged me.  I suggested to her that maybe she needed to tell her daughter that she was okay with her passing, that she wouldn't be upset with her daughter, that the children would be looked after, and that she could finally stop fighting.  
She looked at me. "That's just such a hard thing to do.  I don't want to see her suffer.  I know she's dying, but I don't want to let her go and I don't want her to let us go."  And I couldn't blame this poor mother for her struggle.  Her daughter was so young and had a family to raise.  How can you be okay with telling them that they can and should let go of life?! 
The next morning I clocked in and walked onto the floor.  I glanced into Mrs. D's room through the open door.  The bed was empty and the room was being cleaned.  Just then, Mrs. D's mother walked up to me looking as if she hadn't slept all night.  "I told her," she said to me. "I whispered to her last night that she could stop fighting, that I was proud of her and that I was okay with her letting go........that I loved her and that the children would be okay....I told her not to be afraid and that it was time for her to rest...she passed away at 4am this morning."  I could tell it had been a tearful and long morning/night for her, but she had a look of relief on her face.  After a few shared tears and hugs, she walked off the floor.

Life is precious and worth fighting for.  We should not toss it out quickly or carelessly;
but I learned from Mrs. D and Mr. K that it is a "good night", not a scary, bad, or horrible one that we go into when we leave this life.  It is a new adventure, a release from pain and disability, and nothing to fear when our time in mortality is coming to its inevitable close.  
Fight as long as we can, fight for time, cherish the gift of life that you have been given,
but know that there is no shame to finally go gently and to allow your loved ones to do the same. 
To be honest, I am terrified of losing a close loved one to cancer, nor would I ever want to find myself in the situation of having a terminal illness while trying to raise my family.  
I don't know how anyone could find the courage to allow themselves to go gently and peacefully.......except for to remember what Mr. K knew better than I:  life is wonderful, but it doesn't end with "that good night".  The sun will rise again and we will continue on a new and even better adventure, one that never ends, one that is void of dark nights.  
When we are faced with the dying of light in this life, the sun is merely rising on the other side.  

1 comment:

Tessa said...

Holly, this post was perfect. Thank you for putting things into perspective. Sometimes it's so hard. Thank you.

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