Final Acts: Death, Dying, and the Choices We Make

Whose Death Is It, Anyway?

91 VVVVVVVVVVV Whose Death Is It, Anyway? CAROL K. OYSTER The Beginning It was a nasty, icy morning in January when I drove my father for his first biopsy. I knew he would need someone to drive him home after the procedure , but I was very surprised when he asked me to drive him there as well. My father was very invested in control in all aspects of his life and it seemed uncharacteristic of him to relinquish the driving to me. Although I had just turned forty, having grown up primarily in Southern California I had only in the previous year done any driving in snowy weather. We left with plenty of extra time to reach the appointment and I drove with the advice of a friend—“drive as if you don’t have any brakes”—ringing in my head. My focus on the road kept me from making any small talk, or talk of any other kind. My father was equally silent, perhaps contemplating the ramifications of the possible results of the morning’s tests. We were within a mile of the office when we reached a long, curving, downhill stretch of road. Despite my cautious driving, about halfway down I felt the rear of the car start to slide sideways. In the futile gesture familiar to those who grew up in a pre-seatbelt era, I threw my right arm across my father’s body. “It’s going to be okay,” I murmured repeatedly. I don’t know whether I was referring to the road or the biopsy. I was right about the car, wrong about the test. That morning we began our descent down the slippery slope to my father’s death. My father died on November 21, 1996. He was seventy-six years old. His death certificate lists cancer as the cause of death, and at least indirectly this is true. But his death might be considered a suicide by some because he chose the means and timing of his exit. As his daughter and a participant in the drama I was too involved to analyze what was happening to my father and to the family at the time. As a social psychologist, with the advantage of hindsight , I can now see a number of interrelated issues that affected our journey: the decisions involved; the process of my father’s death; and, finally, the aftereffects of the experience on the surviving family members’ decisions and choices about our own deaths as well as the societally related impacts of our experiences with a planned death. The Medical Progress The diagnosis was prostate cancer. While this wasn’t good news, I remembered having heard that in older men the condition was often not treated since they would almost undoubtedly die of another medical problem before the cancer became a serious concern. What I didn’t know is that the younger one is at the time of diagnosis (and my father was sixty-eight), the more likely it is that the cancer is of a virulent type which is, indeed, a matter for serious concern. And that was the type of cancer that was growing in my father. The progress of the cancer was not extraordinary. The first attempt at treatment was surgery to remove his prostate. Despite the likelihood of side effects from the surgery, my father just wanted the cancer out—a sentiment I completely understood. After the surgery, he told me that the doctors had told him they had “gotten it all.” I don’t know whether that phrase came from my father or from his urologist, but I’ve heard it since from others after cancer surgery. If it is an attempt on the part of the medical community to placate patients and their families, it strikes me as a very cruel illusion to foster. As our family found repeatedly, it only takes one residual cell to restart the nightmare, and the doctors can never know for sure whether they do in fact “get it all.” After the initial surgery began the anxious bimonthly ritual of the PSA blood test (protein-specific antigen tests provide an indirect measure of whether the cancer is still present or active). The first few were close to zero, very good news indeed. In fact, for over a year we lived with the optimistic illusion that perhaps the suspense was over—that Dad really was cancer free. Then the numbers started to creep up, and...