How do you decide when to give
up the fight and focus on making the time you have left meaningful?
by Sherwin B. Nuland, M.D.
We should disabuse ourselves of the notion
that there are definite physical or emotional symptoms which can predict
with certainty that further hope of recovery is in vain. But in spite of
the absence of such fool-proof substantiation of futility, there
nevertheless are certain kinds of strongly suggestive evidence that
almost always appear, as we are approaching the point where good sense
urges that the struggle be discontinued. By careful observation of the
prognostic factor in disease which is most familiar to us -- the behavior
and response of one's own body -- it is often possible to reach a
reasonable decision based neither on the forcefulness of the doctors
nor the misguided optimism of those who love us.
As time and treatment evolve in the late stages of a disease, there will
come a point when our bodies begin to tell us that the benefit of the
therapeutic method being used is proving itself to be less than has been
predicted by the doctors. A variant of this situation is the recognition
that the added suffering caused by the treatment is not justified by its
meagre results. When a change in therapy does not improve the response,
these kinds of awarenesses increase in magnitude, and our bodies are
excellent interpreters of them. After a while, we know without being
told that the time has come to to be realistic about what is at stake
in continuing to harbor unjustifiable expectations. It is then that we
should take counsel with ourselves, and cease to heed the urgings of
well-meaning others that we have yet another go at squeezing out a few
more months of agonized life.
It must be understood that the body's wisdom in such matters is not perfect.
By heeding it we do run the risk of so misinterpreting the signals that we
either quit too soon or persist too long. But such errors are much less
likely than is the far greater mistake to be made when the messages from
within are ignored. For all therapies undertaken when cure is ultimately
impossible, there will finally be a phase of markedly diminishing value.
We must watch for its appearance, and make use of it if we are to bring all
possible peace to the last chapter of our lives.