A Matter of Death and Life by Irvin D. Yalom

Author:Irvin D. Yalom
Language: eng
Format: epub
Publisher: Stanford University Press
Published: 2020-05-15T00:00:00+00:00

October

CHAPTER 15

FAREWELL TO CHEMOTHERAPY—AND TO HOPE

I’VE FEARED THE DAY when we would meet with Dr. M. for an in-depth discussion of ending treatment. Dr. M. arrives promptly to our appointment and answers all of our many questions in a knowledgeable and kind fashion. I inquire about why Marilyn had failed to respond to treatment: we had known or heard about so many acquaintances who lived for years, for decades with multiple myeloma. She responds with a sad look on her face that medical science doesn’t know why some patients with this disease fail to respond to treatment or why some, like Marilyn, experience such toxic side effects that make therapy impossible.

Then Marilyn, never shy, cuts to the chase and asks, “How much time do I have? How long do you think I’ll live?”

I am shocked—and feel sorry for Dr. M. I would hate to be in her shoes. But she seems unfazed and gives a straight answer, “No one can be exact about an answer, but I would estimate that it might be in the neighborhood of one to two months.”

I gasp at this. We both do: we had hoped for and expected three to six more months. Strange how anxiety disrupts perception. I am in such shock that my mind shifts gears, and I begin to wonder how often Dr. M. has to engage in such discussions. I look at her: she is an attractive, soft spoken, compassionate person. I hope she has someone to talk to about the stress she must experience on a daily basis. I marvel at my mind’s agility, caught it in the act of protecting myself: no sooner have I heard the words “one to two months” then I suddenly switch my focus elsewhere and begin thinking of Dr. M.’s daily experience. My mind whirls from one place to another: I cannot bear to hold the thought that my Marilyn might not live more than a month.

Marilyn, remarkable as ever, seems unfazed. She’d like to discuss physician-assisted suicide, and then asks Dr. M. if she would agree be one of those two physicians required to sign approval. I enter a state of shock. I’m not thinking coherently. I’m troubled by learning that she would die by swallowing pills. I had always thought it would be via an IV injection. Whereas I can throw several pills in my mouth and swallow them easily, Marilyn can only swallow one pill at a time deliberately and slowly. What will happen when the time comes? I imagine I could use a mortar and pestle and grind the pills and make an emulsion of the powder. Then I start to imagine her lifting the emulsion to her lips, but that is too much to ask of myself and the images just blur away.

I begin to weep. I think of how I’ve always taken care of Marilyn—she was just under five feet tall and weighed barely a hundred pounds when I first met her seventy-four years ago. I suddenly imagine a scene of my handing her lethal pills and seeing her gagging on them, one after the other.

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