Today, I finally got to reading this article from The New York Times that strongly challenges the ideas presented in The Art of Dying. The challenge comes not from an argument but from a story of someone who decided to use every medical option to fight death until the very end.
Dr. Pardi was a palliative care doctor who often advised patients to enter hospice or otherwise end their pursuit of a cure for their disease and instead focus on living well at the end of life through pain management and time with family, friends, and personal pursuits. But when it came to her own care, Dr. Pardi refused to do the same. Instead she chose radical treatments, fought doctors and hospitals who were reluctant to do all she asked, and ended her life heavily sedated because she was in so much pain.
While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they were painful and offered only a 2 percent chance of survival. When the usual cycles of chemotherapy failed to slow the cancer, she found a doctor who would bombard her with more. She force-fed herself through a catheter and drank heavy milkshakes to keep up her weight.
Eight years after her first diagnosis of breast cancer, Dr. Pardi went to the hospital with a fever. She had been on chemotherapy, radiation, and had surgery already. But after this episode her treatments grew more intense.
Months of constant chemotherapy followed. It kept her alive, but destroyed her appetite. Once an athletic 125 pounds, she had dropped to a sparrowlike 85. She lost her hair and wore a pixie-cut wig. …
Based on her symptoms, the standard medical advice, she said, would have been that she could no longer tolerate chemotherapy, that it “was going to become more of a burden than a help,” and that she should start to think about how she wanted to live out her remaining time.
But she did not want to stop even when she had exhausted standard chemotherapy regimens. So she turned elsewhere.
“What I realized was that if I was still being seen by an oncologist who would be affiliated with the hospital, they would have just said ‘go to hospice,’ ” she said in the interview last July. She was fortunate that she could afford treatments not fully covered by insurance, hundreds of thousands of dollars’ worth over the years.
She was able to leave the hospital, but the treatments continued, and Dr. Pardi fought on. She probably lived longer than possible of she’d gone right into hospice, but she was in tremendous pain because of it all.
Doctors gave Dr. Pardi stronger sedatives. As her body shut down, she began to grow confused and lose consciousness. Mr. Pardi, who stayed at her bedside with her mother, said he and his wife had talked in detail about her wishes. He had no qualms about sedating her, about taking away artificial nutrition and hydration, or about letting her kidneys shut down. Even though she desperately wanted to live, she had said that when it was her time, she did not want to be in pain.
“We had talked about how in some situations, family members want to bring you to consciousness to say goodbye, but that is not for your benefit,” he said. “God, I would have loved to say goodbye. But that was her wish. She never wanted to open her eyes and see people sad around the bed.”
She was 41 when she died in her husband’s arms on Sept. 6, after two weeks in the hospital, seven years as a doctor and nearly 11 years with breast cancer. Her eyes opened in the moment before she died, her husband said, but she seemed unable to see anything.
While this article challenges the idea of accepting death and making peace in our last days, there are a number of difficulties in responding. First, lengthy as it is, this article doesn’t tell the whole story. I have no idea if Dr. Pardi was religious or had actually made peace spiritually. The article suggests that she never came to an acceptance of her death, but really we can’t know. There may have been things in her life that needed reconciling, yet she was never able to do so. In fact, it’s plausible to think that the need to reconcile a relationship or find healing in some aspect of her life is what drove her toward palliative care professionally, and the inability to find reconciliation drove her away from it as a patient.
In the end, we don’t know Dr. Pardi. God does, and therefore we need not–should not–judge her decisions.
Still the story is a challenge to the idea of palliative care. If an expert in the field chose not to pursue it as a patient, then why should anyone else?
First, she suffered tremendous pain and left her family in anguish. That is an option, but one I don’t expect to choose. But also, this story recognizes the difficulty in making a choice that looks very different up close. We think we want to die well, peacefully, and having completed our relationships with loved ones and our God. However, as anyone who diets knows, what we want and what we chose are often two different things.
As Rod Dreher writes about it, “What a terrible position to be in. I think I know how I would choose to handle that situation, but I don’t think any of us can say for sure until we’re in it.”