For Friends and Family: Knowing When to Let Goby PJ Hamel Patient Expert
You’ve been caring for -- or maybe simply just caring about -- someone with breast cancer. That person has come to a fork in the road: continue treatment, or give it up?
Your mom, your sister, your friend is leaning toward ending her potentially life-prolonging treatments in favor of peace and comfort at the end of her life.
You can’t bear the thought of losing her. You desperately want her to give herself a chance at life -- no matter how small, and despite the collateral damage of chemotherapy or other difficult procedures.
She’s willing to die. You want her to live. What do you do?
First, step back. Your burning desire to keep this person in your life is preventing you from seeing the whole picture. Difficult as it is, it’s critical to think clearly: do I care more about my mom [sister, friend] -- or myself?
Harsh as it is, that’s what it boils down to at this point. When your loved one dies, her pain and suffering end. Tragically, yours are just beginning. Looked at logically, is it any wonder she wants to die, and you don’t want her to?
She might survive, you think. She could have another year, or at least six months. They could discover a cure; there might be a miracle.
Again, be logical. More and more, it’s looking as if there’s no silver bullet for cancer. Each case is unique, demanding personalized treatment right down to the genetic level. And “cure” comes in tiny increments. It means an improved surgical technique here, more effective chemo there, giving hormone treatments for 15 years instead of five.
At this point, if your sister has exhausted her options and is deciding to end treatment, she’s beyond any of that. Cancer cures nearly always come at the very beginning. They’re unlikely after months and years of fighting a gradually losing battle against the disease.
Painful as this will be for you, this life-or-death decision is hers to make; give her the respect to make it on her own.
Be ready with advice -- but only if asked
That said, she may ask your advice. So be prepared; think through ahead of time what you want to say to her. If she asks, tell her what you think, speaking from your heart.
It’s OK to express your devastation, to let her know how very much you’ll miss her. But it’s really not OK to beseech her to continue treatment for your sake. She may agree to another round of chemo simply to make you feel better, and then how will you feel as she endures weeks or months of additional suffering, mostly for your sake?
There are always exceptions
Of course, this advice doesn’t pertain to every patient. If an otherwise healthy friend has just been diagnosed and, looking at months of tough treatment ahead, decides she’d rather avoid chemo and hope for the best -- try to talk her out of that decision.
Some women let fear cloud their judgment. If the doctor says she has a good chance of recovering, given she undertakes treatment, gently try to help her see the light. Hoping for cancer to disappear isn’t realistic, nor are unproven alternative treatments.
And if your very old mother is diagnosed with early-stage breast cancer, easily treated via surgery, yet she doesn’t want to go under the knife -- let her know how much surgery has changed since she had her appendix out in 1956. These days, a lumpectomy is same-day, in-and-out surgery, with few if any side effects and a quick recovery time.
But by the same token, if your mom’s cancer is advanced and she doesn’t want any kind of chemotherapy or radiation, support her decision. Just as you’d support the decision of a younger woman who’s already been through the hell of aggressive treatment.
Letting go is the hardest thing you’ll ever do.
But doing so, with grace, is also the most generous, loving way to ease your loved one’s transition from life to death.
Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, advises women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.