Читать книгу Live right, live longer - Ludwig Heinz - Страница 6

The first time I saw Robert Tucker, he was sun-tanned and elegantly dressed. On second glance, I noticed that he colored his still full hair. Eighteen years earlier, at the age of 49, he had immigrated to the United States and gone into the real estate business, having earlier had business connections there. He impressed me as having been quite successful, although I also had the impression that he had invested in an expensive life style rather than providing for old age.

Mr. Tucker had lived a good life, so much was certain, enviably free and often exciting, with friends who lived as he did. In any event, that is how he described it to me. The years went by, his youth was gone, the greatest part of his life was behind him. Now he had colon cancer with metastases in the liver.

Robert Tucker regretted nothing. He had lived his life the way he had wanted to, independent, aware of what he was doing and also of what he had given up. He had always been ready to make his decisions clearly, soberly, and without illusions. He had done that, too, when local doctors had informed him of his illness. He had returned to his native city, Vienna, which many patients in his situation do when they have this possibility.

There were practical reasons for this. Mr. Tucker’s health insurance in the States cost about $10,000 per year. In addition, there was a deductible of 20% for every treatment. As the medications needed for a chemo-immunotherapy cost about $100,000 per year, the deduction plus the insurance meant a personal outlay to begin with of $30,000. The costs for a hospital stay, for the necessary tests, and for carrying out the treatments were in addition. For a self-employed person without major financial reserves this is not a very pleasant situation. I, for my part, could well understand Mr. Tucker’s decision to return to the health system in Vienna, where he had continued to be insured and would at least not have to worry about financing the treatment costs of his illness.

I suspected that he had already been soberly informed about his survival chances and his life expectancy. In any event, we did not talk about either, and we began treatment immediately. A part of this was chemo-immunotherapy, administered every three weeks, so that he could fly overseas between-times. However, the treatments lost their effectiveness relatively quickly. At some point he decided to stay in Vienna, as he was slowly losing strength and had developed a metastasis in the spine, which, after having been treated successfully with radiation, began to grow again and to be painful. We inserted a catheter into the spinal cord in order to initiate continuous opioid treatment.

After a few weeks he asked me for a confidential conversation. »Quite honestly,« he said, »I would like to end it.« He said that every additional day was just an additional burden, and the prospects were not good.

Mr. Tucker had no one outside of his care team with whom he could speak about these things and share his fears and worries. Even those of his overseas friends who were close enough did not come to Europe to see him, and had they in fact come, they would not have been able to stay for the duration to give him support on his final path. Occasionally old Austrian friends visited him, although his contact with them, as far as I could tell, had cooled in the interim.

I told him that his charming personality made him a particular favorite of the team on the ward, quite apart from the fact that in line with our credo we would, as for every other patient, make every effort to attain the best possible outcome for him. Both of these statements were true, of course, but it was clear to me, too, that as motivation to continue to fight it was rather thin. He left it at that, doubtless rather out of consideration for me than out of a newly-found will to live.

A few weeks later, he brought the subject up again. »The situation is extremely burdensome to me, but I have resigned myself to it«, he said. »I just want to see things realistically, I’ve done that my entire life.« He said that despite all the pain medication, he was always in pain.

Also, he was suffering from the side effects of the pain therapy, had a dry mouth, his digestion functioned only with the help of strong laxatives, in addition to which he had the impression that the morphine treatment was interfering with his ability to think. »I’m not the person I was. I’m alone. There is nothing that I could be looking forward to, either a visit from someone tomorrow or something in the more distant future, because, the way things are developing, I don’t have a more distant future. Looked at objectively, continuing to live no longer makes sense to me, quite the contrary. It has become a terrible burden for me.«

It would have been nonsense to speak encouragingly to him again. My one hope was that, despite all of his pain, he might experience at least a few hours that were of value to him. I told him that. But it was not sufficiently convincing to change his point of view. Nonetheless, I could not have fulfilled Robert Tucker’s wish for a premature end, even had I wanted to. It’s against the law in Austria.

As far as that point is concerned, we are living in a paradoxical world. We kill the unborn, who cannot participate in that decision, and in some countries we force adult persons to continue to suffer who have no chance of improvement, are devoid of every other perspective, and who wish to make a rational decision to exit with dignity while they are still competent. The issue here is that there is in fact such a thing as suffering that cannot be alleviated and situations in life in which there is no future, which leave patients with a deep sense of futility and in despair.

There are different approaches to this throughout the world. They range from prohibition of euthanasia, to »passive euthanasia,« which means allowing the ill patient to die if he or she has requested it, to »active euthanasia,« in which the physician on request of the patient administers the life-ending drug – which is what Mr. Tucker asked for and which is legal in a few countries such as the Netherlands and Belgium –, to physician-assisted suicide, in which the patient must himself take the lethal dose provided by a physician – the case in Oregon and other U.S. states –, to assisted suicide in which the assistance does not have to come from a physician (as in Switzerland). For all of these variations there are careful measures in place to prevent any possible abuse.

All we could do for Robert Tucker was what is called palliative sedation. That made it possible for him not to have to suffer pain in his final days.

In the meanwhile, he put his estate in order. To this end, a notary spoke with him at bedside. Given what I had come to know about him, I suspect that he left his remaining financial resources to a charitable organization. He made his body over to the Medical University to be used for teaching purposes. He had earlier been informed that his remains would be buried in a specially designated grave provided by the City of Vienna. I admired him for the sobriety with which he proceeded in this issue. I told him that in our last conversation.

We also talked about death. I told him of the many similar reports from persons who had had near-death experiences. These are persons who, for example, have been reanimated after a circulatory collapse. While these persons are being reanimated, they experience the separation of their consciousness from their body, which floats, for example, above the cardiac emergency team that is working on their heart. They remember many details of the efforts of the emergency service to save them, and they describe as with one voice a never before experienced feeling of euphoria. It is true that no one can prove that this is also the case at the time of actual death. But these persons have the impression of being pulled forward through a tunnel by a glorious stream of light into a world of sanctuary and bliss. »Should this be the reality,« I said, »then we shouldn’t waste another day on this earth, but instead follow the blazing light into happiness.«

»That certainly sounds fantastic. Only, I lack the necessary faith,« he answered. »It’s okay for me to go. But it would in fact have been helpful if there had been a few people I could now say goodbye to. But then perhaps all of this would have developed differently anyway.«