A World of Madness

Because I have expressed my willingness to trade quantity of life for quality of life, MSKCC's palliative care unit's protocol for me yesterday included having me see a staff psychiatrist to make sure that I am not depressed. The psychiatrist seemed to agree with the palliative- care professionals, and with my own assessment, that I show no signs of depression. As I have tried to reassure all concerned, my thinking about quality of life versus quantity of life and my personal disinterest in staving off death to a bedridden, drug-addled bitter end were formed long before I was diagnosed as an incurable.

Yesterday, I also continued an extended conversation with the professionals in the palliative-care unit not only about what they might be able to do to alleviate some of my symptoms, but also about the limitations on their care in general. (Given the boundaries of laws and medical ethics, I doubt that their limitations are any different from those of professionals in other secular cancer centers.) My understanding is that much of what they can do is to try to 

alleviate patients' pain with opiates. The opiates in turn cause constipation, which can cause an anal fissure, as indeed happened to me in the aftermath of all of the complications from my second surgery. If I had to choose between being dying sooner and getting another anal fissure, dying sooner would be an easy choice. As the doctors tried to do after my surgeries, the palliative- care doctors and nurses try to offset the opiates with other drugs to avoid constipation, while trying not to trigger in turn diarrhea. Palliative care can also include palliative sedation in the final stage of dying, but not before.

I told the professionals in the palliative-care unit that, to me, taking palliative drugs that would require taking other drugs to treat the side effects of the palliative drugs, and so on, was a form of madness. The nurse-practitioner nodded and said that was the world in which they worked, a world of madness. I replied that I very much wanted to avoid entering that world. As I told them-- and they tacitly seemed to agree-- I think that the only alternative for someone in my situation who does not wish either to enter that world of madness or, out of respect for the sensibilities of family, to commit suicide, is simply to stop taking food and water once further prolonging of the dying process seems unwise or intolerable.

In the meantime, I agreed to go back for a third time to the Urgent Care Center to see if the doctors there or in Interventional Radiology can find some way to put a needle in my body and drain from it some of the steadily mounting fluid. And I agreed to try some non-opioids, that supposedly do not cause severe side effects,  to try to alleviate some of my symptoms. Fortunately, I read the package insert before I actually took one of the pills: one of the possible side effects of this non-opioid painkiller is constipation so severe that it requires manual extraction of the feces.