Death Be Not Proud

TON - October 2012 Vol 5 No 9 — November 19, 2012

John Donne, a 16th century poet, wrote a work called “Death, be not proud” (also known as “Holy Sonnet 10”) about death. One line in particular always catches my attention: “….And soonest our best men with thee do go.” Donne stated the obvious: everyone dies, and for many, death comes too soon.

Benjamin Franklin also addressed the inevitability of death (adding a little to it) when he famously wrote in a letter to Jean-Baptiste Le Roy in the late 1700s, that “In this world nothing can be said to be certain, except death and taxes.” In our modern culture, often hailed for its lack of profundity, death also lives. The Band Perry, an American country group, sings of premature death in their hit song “If I Die Young.” In the hit movie saga “Twilight,” death makes up one of the principal themes, albeit ironically, through a story of the undead. Mass media headlines throughout the world herald the death of thousands, every day, of every ethnicity, and of every cause, leaving unreported the demise of thousands more. The point is, death is everywhere.

Well, everywhere except on the cancer ward. Nope. On the cancer ward, no one ever speaks of death. Certainly, patients are encouraged to have ad­vance directives should they become incapacitated. Oh, and there are memorials twice a year (more for children) in the nondenominational chapel for those who succumb to cancer, which I discovered by looking at my hospital’s webpage (it is the last item on a long list of other services for patients). But bulletin boards in the ward’s hallways announce birthdays, exercise groups, and inspirational quotes. Doctors and nurses talk about progress forward, what is next, and how to cope with the side effects of treatment. Cleaning personnel mop the floors and talk about how they hope the day goes well. The blood folks sneak in very early in the morning, draw the blood, clean up, and go on to the next patient. All the hospital personnel on my floor go about their business as if death did not exist.

But this is a cancer ward, chock full of horrendously ill people, and some of us are going to die very prematurely, some of us maybe even today.
“What happens to the people who die on this floor?” I asked my CNA when she came in to check my blood pressure last night.

An awkward silence followed. I felt the blood pressure cup tightening around my arm. Clearly disturbed by my question (and, perhaps, under instructions not to talk about death with patients), she gave me her answer. “I really do not know,” she told me. “I have been here for 3 months, and I have never heard of anyone dying on this floor.”

“Incredible,” I felt like replying in a biting, sarcastic tone. “Here we are on a floor of pure cancer patients, many who are preparing for or have undergone a stem cell transplant, others who I hear gagging for breath, and yet others who cry out in the night for pain medication that always seems to arrive only after at least a few minutes of excruciating suffering. Yet, none of them die of this often terminal illness. What an amazing hospital this must truly be—full of cancer patients, none of whom die. Alleluia. Praise be that I am here!”

“Oh,” I actually replied, kindly, as she wrote down my blood pressure reading on her folded piece of paper. “I imagine that they do die, but we just do not see them. Maybe they get left in their room and are snuck out, covered in a sheet, when no one is around. Or maybe they just get transferred to the ICU when it is clear they will die.”

“Maybe,” she said with an uncomfortable chuckle. “You have a good day!” She gathered up all the blood pressure paraphernalia, turned, and left my room.

Why all the silence about death? And, really, what does happen to the people who die on this floor, and why will no one admit that people actually die in this hospital?

When you keep your silence and do not tell me, I am forced to come up with my own theories. I, for example, firmly believe that patients on the verge of death get sent to the ICU (my other theory—dead folks lying cold in their beds until they can be snuck out under a white sheet—seems too Holly­wood-ish to me). I have heard hushed comments and seen sideways glances in the hallways among nurses as they share the information that, “Oh, so and so got sent to ICU.” It is as if those patients should not be talked about in a normal tone. They no longer have the privilege of being on this floor with all of us, the survivors. Instead, as death approaches, they are banished to the mysterious I-C-U, a wasteland of the almost dead. Hospital personnel, nurses included, certainly do not want the death of the few to impede the recuperation of the many! Those on the verge of death somehow failed—they did not try hard enough, or they did not follow their medication schedule to the word, or they did not have the innate inner strength to survive. They need to get off this floor!

Admittedly, this is a cynical and probably unproductive accommodation of fragmented facts, or rather my interpretation of what seem to be the facts. However, if I am not told the facts, if I do not get even a general idea of what would happen to me should my death be imminent, what do you want me to think?

My life would be a lot easier if my nurse, upon my admission to the hospital, would tell me something like: “Of course we do not expect that you will pass away during your stay here. Most patients go home. However, should we perceive that you are at an imminent risk of death, you will be transferred to the ICU to get the intensive care you need (note: you can substitute here whatever the real process is). When you are better, you will come back up here to this floor.”

That is all. You do not have to go on and on about death. We do not have to fall into a depression. I just want to know what will happen if the outcome of all this is not what I, my family, and friends would have hoped for. I want to be treated with dignity even should I not make it. I don’t want it to seem that because the disease beat me that I somehow lacked inner strength, or was an embarrassment to the cancer patient team, or did not love my children—and my life in general—enough to survive. I do not want to ever feel I have been banished from the living.

Death should not be proud. Yet, cancer patients and oncology nurses should be. Part of maintaining that honor is addressing even the most difficult issues. Death, obviously, is one of those.


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