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The Good Fight

by Kathy Snodgrass

When my husband W. D. Snodgrass learned that he was terminally ill with lung cancer in September 2008, he was, at age 82, still intellectually and emotionally vital and just as certain as he had always been as to what his response would be. Realizing that any treatment might buy some time, but certainly at a terrible price, he chose Hospice.

De (his lifelong nickname) had long embraced Freud’s maxim about what made for a meaning-filled life--love and work–and he excelled at both. For almost twenty-eight years he was the best of all possible husbands; for almost fifty years he was an accomplished and acclaimed writer who was awarded the Pulitzer prize for his first book of poems, Heart’s Needle. Up until a week before his death he was revising his last poem and as he took his last, easy breaths, I held him in my arms. When it comes to dying, it doesn’t get any better than that.

For almost four months preceding De’s death, we were focused not on dying but on living well, and for that and so much more we owe an un-payable debt to Hospice and Palliative Care, Inc., of New Hartford. For a host of personal and cultural reasons, choosing to enter hospice care can be agonizingly difficult. When responding to terminal illness our society automatically invokes war metaphors. Pick up the daily newspaper and you’ll read of someone having “fought valiantly,” having “never given up.” Several obituaries of my husband led with having “lost his battle with lung cancer.” Not to give up means undergoing treatments despite a diagnosis that leaves no doubt as to the outcome. It’s no wonder, then, that in many people’s minds choosing hospice means giving up the fight, surrendering to death. It’s the fight and the attendant suffering, physical and emotional, that people looking in from outside that circle of pain find admirable. Thanks to Hospice’s help on any number of levels, De and I were fortunate to have lived in a circle of comfort and security, intimacy and joy.

We fought no battles because at the very outset we won by choosing Hospice over treatment. We won because we lived life as fully as we could, with as much dignity, humor, and sweetness as we could wrestle from each day. We won because De died without experiencing any physical or emotional torment. We won because Hospice was there from start to finish, providing all the resources and hard-won knowledge at its command. Moments after De died, I found myself paraphrasing a passage from one of St. Paul’s letters: We had fought the good fight. We had finished the course. We had kept the faith.

While recalling my husband’s last months, I came across an interview with the novelist, Richard Ford, in which he explains why he once chose to write in the present tense: “The novel gets to say we’re present tense here, and yet we can read the present over and over again. Which is quite a nice thing to do, we’d all be better off if we could not stop time but slow it down a little bit, and live the pleasant things more pleasantly. . . .”

Looking back at De’s last months, I remember it as a luxuriously long stretch of closeness and simple comforts. Time seemed to slow down because Hospice helped to live so securely in the present. We weren’t looking regretfully behind our shoulders at the past; neither were we looking anxiously ahead. When friends and family would call or write for the first time, they would be tongue-tied and awkward, fearful of piling pain or what they assumed was a mournful, pained existence. De and I did the cheering up, reassuring them that we were safe and cared for, that we could turn our energies toward ourselves: to a good meal, a glass of wine, along with yet another Netflix movie. During one of the worst winters in recent memory, living on a country road that went unplowed for long hours, we never had to concern ourselves with essential services since all the equipment and medications were delivered to the house. More important, De didn’t have to steel himself for cancer-related pain or even discomfort, not with liquid morphine on the bed stand. I am convinced that he lived as long as he did because he was so well cared for in mind and body, living by his own needs and desires. So much for the irrational fear that Hospice speeds up death when, in fact, it helps to create a secure and satisfying life lived in the present tense.

If I could talk face to face with someone contemplating Hospice care, I would stress how precious time is when it’s running out, and how crucial it is to have time not for its own sake but time in which to live with confidence and tranquility in the present. During both the pre-admission and the admission interviews, we were quietly dumbfounded when congratulated on our decision to enter Hospice early. There was no doubt that De was terminally ill; his doctor had confirmed, in writing, that he had six months or less to live; we had decided, weeks in advance, that we would not pursue any cancer-related tests or treatments. We couldn’t wrap our minds around anyone considering our decision “early.” In our minds, De was admitted to Hospice just in time.

From that chest x-ray to diagnosis to admission to Hospice, a mere three weeks passed, but it was a long, anxious time. Everyday I watched De grow weaker; everyday I feared he would suffer a horrific fall and we would have no choice but to call the ambulance and go to the hospital, and if he were admitted, my fear was that he would never return home. A well-meaning pulmonary specialist wanted first a biopsy. Only when we discussed canceling the procedure did the doctor admit that the bronchoscope might not provide a definitive diagnosis. Almost another week was wasted because we acquiesced to the doctor’s request–admittedly, he said, a “long shot”–that De take Prednisone for a week so as to rule out a non-malignant condition. All the while, however, the pulmonary specialist is repeating the same sentence: “Lung cancer would be numbers 1, 2, and 3 on my list.” The teeter-totter of yes, it’s malignant but maybe its non-malignant made me feel like Alice falling through the looking glass. Once again we cancelled an appointment and made the call to Hospice. From the time of the first chest x-ray to admission to Hospice: 20 days of agonized waiting, and worse: for the space of a few minutes, because of an enhanced sense of well-being caused by the Prednisone, my husband experienced the baseless hope that he wasn’t terminally ill, that perhaps it was just an “infection.”

If we had not been unwaveringly intent on entering Hospice, those 20 days could well have extended another 20, even more. I remember crying from sheer relief as De signed the Hospice admission form. I knew we were safe from the ministrations of well-meaning doctors whose professional lives revolved around treatment options. More to the point, we were in the hands of those who didn’t look away from the reality that wasn’t going away.

The second, equally crucial point I would make to someone contemplating Hospice would be about pain. Hospice talks about “pain management,” and while it’s an accurate description, it has a blandly clinical sound. There is a generally held assumption that terminal illness and pain go hand in hand. De never had one moment of cancer-related pain. The times when he experienced shortness of breath, the liquid morphine provided immediate relief. We couldn’t help but laugh at the fact that although De was dying of lung cancer, his main complaints were the cannula’s irritation to his ears and nose and an ingrown toenail.

As for emotional distress, my initial fears revolved around my having to “manage” De’s pain, should it come. Both the liquid morphine and the potent anti-anxiety drug, Ativan, were at the ready; Maryann, the nurse on call, was a phone call away. Even so, I can well imagine that many people would think that a hospital setting would be the more rational and caring choice, that there would be professionals who could make the best decisions, in a flash, that would make all the difference. I have no doubt, however, that there is no more rational and caring choice than Hospice. De and I were together; the necessary pain medications were at the ready, and professional help was available around the clock.

We were lucky. De had almost four good months under Hospice care. And then there were the last three days of his life when he was actively dying. Time abruptly lost its leisurely quality; instead, we were in a crisis mode that Hospice was fully equipped to address. In record time Maryann ordered a hospital bed sent and assembled; Mary, the night nurse, arrived on yet another snowy evening to insert a catheter and to ease De through his last two nights on earth. When he began experiencing terminal restlessness, the liquid morphine and Ativan swiftly countered the biochemical reaction of his organs’ breakdown. As a result, De was calm and content, able to communicate his love and his sweetness until almost his last breath.

So far I’ve been talking about Hospice as a faceless entity when, of course, it is the people of Hospice who make it the refuge and the lifeline that it is. Many of my contacts were only by telephone, but they were no less precious for that. Just about every morning as I waited for the clock to change from 7:59 to 8:00, I used to wonder how often Frank of the calm and reassuring voice would arrive at work knowing that the phone would begin to ring as soon as Hospice officially opened. On weekends there was the nurse on call, Maryann, whose voice had that same gentle, soothing quality. More important, however, she possessed the ready knowledge and quick thinking that in a time of crisis–namely, my husband’s last weekend–enabled us to weather the worst together.

But no words can adequately describe our debt to De’s nurse, Roseann. We looked forward to her bimonthly visits not only because of her endless supply of concrete help and advice but also because of her partnership in De’s dying. It’s telling that the word, “dying,” never surfaced during those visits. The reality of De’s dying was always the elephant in the room, but it was a docile, house-trained elephant that sat quietly in the corner. Instead, Roseann’s visits were all about life right here and right now, about what De wanted, about what De feared, about what I needed to know to make him as comfortable and as easy in mind and spirit as possible. In our warm, music-filled bedroom, time did seem to slow down for the space of her visits.

Trust can be hard to come by and harder to keep, but from start to finish we had it with Roseann. Early on De shared with her his lifelong fear of strangling or choking–a fear that naturally came to the fore when he was diagnosed with lung cancer. Roseann quietly assured him that he would never experience that terror, and he never did. The day before he died, when he was semi-conscious for the most part, Roseann was at his bedside for three hours. When she arrived and leaned over to say hello, De opened his eyes and greeted her with one of the endearing nicknames he had christened me with: “Hi, Pussycat. . . . Oh, maybe I shouldn’t call you that.” I quickly assured him that he was allowed more than one pussycat in his life. Roseann–the embodiment of Hospice’s great and wonderful gift-- had more than earned that love-filled nickname.