The fierce fight over how to die
There has been an ugly and sad pile-on by two people who ought to know better and a young woman fighting against cancer. It started — as these things can — in the blogosphere, where Lisa Bonchek Adams, mother of three and terminal cancer patient, has been chronicling her battles in sometimes raw detail.
Her tweets are full of pain, literal and emotional. Apparently, her revelations have proved too much for journalists Emma Gilbey Keller and Bill Keller. In a post on theguardian.com, Ms. Keller suggested that Adams has gone over the line.
â€śShould there be boundaries in this kind of experience?â€ť Keller wrote. â€śIs there such a thing as TMI? Are her tweets a grim equivalent of deathbed selfies?â€ť
For starters — before we get to the heart of the thing — do you really want to be hip and clever by tossing around the word â€śselfieâ€ť when talking about someone dying? Death, after all, can be pretty personal.
Then her husband, Bill Keller, former executive editor of the New York Times, weighed in on the Op-Ed page of his paper, perhaps coming to his wifeâ€™s defense. He contrasts Adamsâ€™ adamant and self-revelatory fight with his father-in-lawâ€™s calm death from cancer in a British hospital.â€ť That, said Keller, was a â€śhumane and honorable alternative to the frantic medical trench warfare that often makes an expensive misery of death in America.â€ť
Emma Keller may sound a bit mean-spirited. Her husbandâ€™s remarks, more sober and big picture, are aiming at something larger, however. He is examining one of todayâ€™s hot topics: How to Die.
Everywhere you turn now, dying is getting big play. No doubt because we noisy boomers are aging. We are burying our parents and our spouses and our friends — reckoning with the processes and the losses.
There are good books being written, like Katy Butlerâ€™s Knocking on Heavenâ€™s Door and even TV reality series like Showtimeâ€™s Times of Death. I read the former but couldnâ€™t take too much of the latter. This is tough stuff, not to be made light of by cutesy references to selfies.
At least Bill Keller is trying to raise those legitimate questions everyone seems to be asking now. The problem is he is doing it over Adamsâ€™ failing body. Heâ€™s got the wrong person, the wrong patient.
Kellerâ€™s father-in-law was 79 when he died, almost a lifetime older than Adams, who is in her 40s. If you are in the middle of life, with young kids, fighting like a tiger to stay around for a few more years — to see a graduation from middle school or a prom dress — makes a damn lot more sense than if you are in your later years. I would do it in a heartbeat; would have done it.
Not to see this and make a major distinction is a failure of imagination. Adams is not an old woman. She is flailing against the injustice of a premature death.
There is also an underlying prissiness in the Kellersâ€™ approach, a kind of preference for a stiff-upper-lip approach to death. Call it more British, if you wish. Letâ€™s keep the emotional water level down. Letâ€™s not let it all hang out.
But attending someone who is dying is not about keeping the emotional water level down. That is hard to do when you hold someone who is nauseated from chemo; or change a diaper on a once-robust-now-frail mother; or bandage a husband who has taken a fall and cracked his head open, spilling blood everywhere, because of the Coumadin he is taking.
Because it is messy and heartbreaking, this ending business — if you are present, truly present. It can even be messy and heartbreaking and painful if the patient is in hospice care, the increasingly promoted gentler way of dying. Leaving the earth can still be fierce — for the patient and for those who love him or her — even without the expensive, life-prolonging interventions.
We all have to be careful not to imply there is a right way to die. I have learned, watching the three people I have recently lost — my mother, my husband and my best friend since high school — that people should get to choose how hard they want to fight and when they want to go.
To question a young woman grasping at life-prolonging interventions is simply cruel. I have a close friend, Dikla Benzeevi, who is, like Adams, a Stage IV breast cancer survivor. She knocks me out and makes me feel small. I met her some years ago, when she was just finishing her first round of chemo. She was in her 30s and had never been in love. Kids, whom she had longed for, were now out of the question. A year later, the cancer came roaring back and she has been fighting the beast ever since: spine surgeries and endless rounds of chemo and those nasty pills that suppress your hormones so you are dry and scratchy all through your being, from skin to soul (so sex with the boyfriend you always longed for and finally got can be difficult; is this TMI for Emma Keller?).
Like Adams, Benzeevi has gone public, starting support groups and turning herself into an international spokeswoman for young women with breast cancer. Death is always close. Of the 10 women in one of her support groups, Benzeevi is the only one left. Like Adams, she will keep raising her voice until she canâ€™t.
Even for those who are older, the choices about how to die, about how hard to fight, about when to give up, are intensely personal. I donâ€™t think any of us know how we will react when that times comes — the Kellers included. They might have a moral and personal leaning toward going in a decorous, uncontested fashion, but I just donâ€™t think that is assured.
Along with Benzeevi, three other people I am close to are now engaged in major cancer battles. I am rooting for them with everything in me. Some are more public about their battles than others. Fine; thatâ€™s a choice, too.
Obviously, if someone becomes incapacitated and the medical wizards plow on doing their life-saving thing, there are issues — as Butlerâ€™s book makes beautifully and painfully clear. Obviously we all need to talk more about advanced directives and hospice and all that.
In fact, we are talking about it. People like Adams are helping advance the conversation in its rawest, saddest form. We owe her a thank you, not a clever, rhetorical slap on the wrist.
And the Kellers owe her an apology.
ILLUSTRATION (TOP): Matt Mahurin
PHOTO (INSERT 1): Sample analysis tubes are seen in a lab at the Institute of Cancer Research in Sutton, July 15, 2013. REUTERS/Stefan Wermuth
PHOTO (INSERT 2): A patient receives chemotherapy treatment for breast cancer at the Antoine-Lacassagne Cancer Center in Nice July 26, 2012. REUTERS/Eric Gaillard