Monday, July 26

Path of no return

Today four years ago that day, when, eating at his house, a friend told us that he had cancer. I remember that, as I went along, I only came up with those hackneyed phrases that try to deny a reality by sweetening it, such as: “Today there are cancers that are cured” or “with current treatments great survivals are achieved” and so on. The reality is that we are all overwhelmed by that word, and we want to free ourselves in any way from the anguish it causes us. I also remember that I avoided using certain militaristic metaphors so used on those occasions: “Have courage to fight him”, or “you will surely defeat him”, as if it were a combat between warriors. When these militaristic metaphors are used, inadvertently, they are stigmatizing the disease and, therefore, those who suffer from it.

What we show by using them is the fear they produce in us, like the fear we feel of the enemy in a war. By using these metaphors, the very reputation of cancer increases the suffering of patients, and their imagination is filled with all the negative connotations that the term has; there is an inevitable relationship between demonizing the disease and blaming something on the patient, no matter how much we consider him a victim. Victims always suggest innocence and the victim, by the underlying logic of every term that exposes a relationship, assumes guilt. We should try to calm the imagination of the person who suffers from cancer, so that they do not suffer more from thinking about the disease, than from the disease itself, and for this we would need to talk more among ourselves about everything that is not supposed to be named. And so we did: we talked about the possibilities of cure according to the type of cancer and the ailments that it had, and that now should be left in the background. At the end of the conversation, my friend said by way of farewell: “You see how quickly life changes, one day you wake up, and in an instant, life, as you knew it, is over.”

From that day on, three years of penalties began for my friend. He could not be operated on due to the location of the tumor, and the oncologists indicated a treatment with chemotherapy and radiotherapy. Over the months, as the treatment cycles went through, the side effects began to appear. One season he had difficulties with feeding because the radiotherapy had irritated his esophagus, others, he had a stabbing pain in his side, with fever, which forced him to be readmitted to hospital, to drain the effusion that had been produced by a lung infection; later, he began to have difficulty breathing, because his lungs showed his years as a smoker. We continued to see each other frequently, cultivating that friendship of many years that unites you with some people, and you feel it as a help to live; although sometimes, we had spent time without seeing each other, when we did, we would resume the relationship and the conversations as if we had interrupted them the day before. I was always impressed by the fortitude and serenity with which he maintained himself in the face of illness.

At the end of the third year, I began to notice that he had a tendency to talk about the past, about his past. He proudly recalled the years of anti-Franco political militancy at the university, the episodes of the political transition to democracy, lived from the perspective of the extreme left, and even the yearning for new life experiences from the years of the Madrid movement. Perhaps the feeling that his end was approaching forced him to take an inventory of what he had experienced, or he wanted to remember everything that he had felt as true in his life, because as Siri Hustved wrote “what we do not feel we end up forgetting”. Thus, we configure memories to give them meaning and coherence. For healthy people, it is easy to find what role we want to play at different moments in life, and to interpret it in the reality of our present, but in the world of seriously ill no one knows Living with his present, he only wants to escape from it, because the disease provides you with such a bastard form of identity that the patient does not know what to think of himself in his present and, therefore, he needs to reconstruct his past. William already said it Faulkner: “The past is never dead, it is not even past.”

Despite continuing with the treatments, my friend’s condition did not improve, he already needed continuous home oxygen, and, finally, the oncologists terminated them and referred him to palliative care. He understood that his illness was irreversible and that the new medications that were prescribed were for the sole purpose of relieving pain and suffocation. One day he told me that he did not want to continue like this, that if his illness was hopeless, he did not want to die by suffocation and added that he was going to ask his oncologists and the palliative team to give him deep sedation so that he could die without knowing anything. and turning to me he said: “But I want you to be present that day.” I agreed, without asking anything and without hesitation, although I did not know what my role would be. I have always had the conviction that a human life submitted To pain and physical suffering, due to an incurable disease in the terminal phase, it is not worth living for anyone, since it degrades the human being, forcing him to live an inhuman situation. Perhaps we rarely notice the pain of others in these situations, because our pain is always making noise at all hours, and that noise incapacitates us to listen to the other, and offer our consolation. Chance wanted that, in those days, a bill of eutan was processed in Parliament Asia and those apocalyptic voices would be heard once again prophesying the end of Western-Christian civilization if euthanasia were approved, as they did years ago with divorce and abortion. These voices continue to be fanatized by the religious fundamentalism of the hierarchy of the Catholic Church, which tries to prevent legal protection for a dignified death. This justification of which they boast, of presenting themselves as defenders of life, is a cruel sarcasm, because those patients are never in a position to enjoy it, and, furthermore, they hide that with their position they are condemning them to martyrdom, since living in these conditions is to die a thousand times every day until the torture ends “naturally.” These voices, in addition to showing an exacerbated authoritarianism over Spanish society, not respecting those of us who do not belong to their flock, also show that they ignore that the right to live is not threatened by the right to die, but rather reinforced, because there is nothing like the reference of death to appreciate the infinite riches of life. I have often tried to understand the reasons for such dogmatic behaviors, including totalitarian ideologies, which do not recognize that times change, certainties vanish and the life of the orthodox, faced with the rapid passing of things and perspectives, has It is increasingly precarious and melancholic. That rigidity that guards immutable truths reveals a fragile and sensitive intimacy, a soul that seeks protection for its own sentimental vulnerability, behind the armor of an unshakable faith. Perhaps we all suffer for the world that changes, for the truths that pass, for the faces of loved ones that move away, for the innumerable loss of things and an attempt is made to present a reassuring order, but the stranger the world becomes, the more we become. we isolate ourselves in stubborn loneliness, pathetic and painful, yet seemingly rigid and inflexible.

Several weeks passed in which they completed the administrative procedures, living will etc. And one day, they told me that everything was ready. I really did not know what my role was going to be, and I was afraid of living dramatic scenes with the family. In forty years as an intensive care physician, he had experienced many deaths, but never that of a friend and at home. When I arrived, the atmosphere was calm and peaceful. The palliative team doctor was slowly explaining to my friend that he could retract his decision or postpone it without any inconvenience, but he insisted on going ahead and dying without knowing anything. The doctor wrote down the clinical report and the medication administration schedule that they started next and added that he and his team had to go to other homes to attend to other patients, but that they would return, and that they could be called by phone at any time. moment. It was then that I offered to apply the guideline myself in his absence, and in that moment I understood the role that destiny had assigned me. In the following hours, I continued the administration, and had to shorten the intervals between doses to achieve continued sedation. Without realizing it, I was letting myself be carried away by the intellectual scaffolding that the practice of the profession provides and that shapes our minds. Any profession marks the person who exercises it, and conditions the way they act throughout life. The proximity of death is a fact to which the medical specialty habituates you, and that gives you an external appearance of tranquility, which sometimes surprises those around you and does not correspond to what you feel inside. You receive the looks of others, and they make you see how you are acting and, in this way, you are defined as you are before others. My obsession at that time was to fulfill the wish of my dear friend, and what I felt or did not feel was secondary. While he was sleeping soundly, we, family and a friend, accompanied each other between inconsequential conversations, whose main purpose was to pass the time. This is how the afternoon and the night passed and at dawn he left us.

Although death is the cancellation of life, we must consider that it is an inherent part of it in a natural way. So is feeling the pain of losing someone you love, and who has been part of your life. Six months have passed since then, and today we have come together to remember him because he would have turned 70 years old. His absence permeates us all without leading to a nostalgic melancholy, and we feel a new inner impulse that makes us live the present with more intensity, because as Kierkegaard said “life can only be understood looking back, although it must be lived looking back. go ahead”.

Acknowledgment: To Joan Serrano for correcting the manuscript.

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