Keep slogging through or turn back? A palliative care question.

A good friend visited yesterday. Before he arrived, the spring day had brought both showers and sunshine. We chatted for a while, catching up. Then – noticing a break in the rain – we decided to take a walk in some nearby woods.

Several years ago, a woman (whose story has been altered here for heathcare confidentiality) decided to visit her doctor because of a long-lingering cough.

As my friend and I started off, the path was still wet. Although I've been on this trail scores of times, he'd not been here before. He spent a few moments appreciating the craftsmanship of a hand-built bridge we crossed as we left the city sounds behind.

Her doctor told her that the diagnostic results weren't conclusive, and that she could elect to have an MRI if she wanted to know more. The woman decided she wasn't concerned enough to have the MRI.

As my friend and I walked, mostly in silence, rain started to fall again. We've both lived in Western Oregon long enough that there seemed no reason to turn back – not when there was a good trail ahead of us and the whole afternoon to spend together.

Over the months that followed, the woman started noticing strange pains. She mentioned them to her doctor, but they were more a nuisance than a concern, so she again declined further diagnostics.

After a stretch of wide, open trail, my friend and I reached a meadow. Apparently there had been few walkers there recently, and the trail was covered in ankle-high grass. Puddles had formed in the low spots. I began to wish I'd worn boots.

Soon, the woman was feeling listless and she didn't venture into town as often as she had previously. Her children – all grown – helped as they could, and she managed the rest. She still gardened and spent sunny afternoons on her deck, with her dog at her side.

Another bridge, then into the woods. Even quieter, now. The last of the trillium flowers. Beautiful violet bleeding hearts, with their delicate flowers rising above their ferny foliage. And the light smell of the first skunk cabbage.

The woman's restful days on the deck turned into days spent on the couch, reading – which had always been one of her favorite pastimes – and watching the news to cheer on her favorite sports teams and candidates. She quit going to book club and exercise class.

As my friend and I took in the peace and beauty of the woods, rain started to fall. But still no reason to turn back now, when there was still more to enjoy. He asked me about a certain large tree I've mentioned, so we headed that direction.

One of the woman's children who lived nearby, seeing how much her life had changed, offered to drive her to the next doctor appointment, and the woman accepted. At this appointment, the woman agreed to have an MRI.

Now the rain began to pour, as Oregon rainstorms will do. We continued, hoping it would let up, and wanting to reach the tree: he to see it and me to share it.

The MRI results came back, showing cancer in the woman's lungs. "You'll probably have less than six months," her doctor said. A CAT scan was scheduled, and an appointment made with an oncologist to explain its results.

It was raining harder now – pouring seriously – but we were so close to the tree now. Let's at least get that far, we decided.

Several of the woman's grown children went with her to see the oncologist. One had taken time off work; another arranged for someone else to pick up her kids after school.

As we reached the tree, the sight was inspiring, even in the downpour. The calm of the woods filled us. We were glad we'd come. But we were also wet. While we were both wearing rain jackets, both of our jeans were starting to stick to our calves. But the temperature was warmish, so we weren't going to catch a chill.

The oncologist explained the extent of the cancer and recommended surgery. "We can't cure it," he said, "but we could probably give you more time."

At this beautiful tree, we had a choice. We could go deeper into the woods and hope the rain would let up. Or, at least, not get worse.

The woman could choose surgery in hopes of more time. She's a strong woman, who's been through a lot. She has grandchildren, and the youngest are in their last year of high school. She dotes on them all, and they are just beginning to turn into adults.

My friend and I looked at each other. "We got to see the tree, but my legs are soaked to the skin," he said. "Mine, too," I replied. "I'm enjoying this," we both said, nearly in unison, "but…."

"No, thank you," said the woman. "I've lived a full life. I'm proud of my children and my grandchildren. I have no interest in trying to extend my life any further than whatever I'll have with this cancer." The oncologist nodded in understanding and proceeded to describe how palliative care could alleviate pain and suffering as the disease progressed.

And so we turned and headed home. Our conversation turned to how long we'd known each other and some of our adventures. When we got back to my place, we changed into dry clothes, threw the wet ones into the dryer, and had a cup of tea, contentedly watching the rain from inside.

And so she went home to sit on her sunny deck with her dog. Family members rallied to provide the care she needed at home, and those who lived out of the area visited as often as they could. She lived seven more months and attended the high school graduation of her youngest grandchildren. I know that meant the world to her.

It was a wonderful walk. I'm glad we went. I'm also glad we stopped and made a conscious decision about whether to continue pushing into the woods, risking even wetter, colder, heavier clothes – or skip the potential for further adventure and turn back to the cozy warmth of the house. Other people might have made different choices, more suited to them. But we had done what was important to us, and had no need for more slogging.

She had lived a good life: had great fun as a youngster, took action for social justice as a young adult, married, raised the kids they had together, and contributed to her communities through work and, later, volunteering.

When her doctors gave her the choice to keep slogging to gain more time, she made a conscious decision not to, based on what was important to her: living out her life in her house with the sunny deck. Other people might have made different choices, more suited to them. But she had no need for more slogging.

She died peacefully, in her own home, surrounded by her family telling her they loved her.

I was one of those children at her side that last day. I still miss her.


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