11.(33-37) Secrets of Cancer 2

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33. E Herself

The room is shabby but clean, the windows covered over with brown curtains. Sleep mat has brown cover and an apparently sleeping E under a sheet between mat and futon cover. In the faint light, Kimi makes out E's frail figure. Her open pajama top reveals hollow at each side of neck whose overlying flesh is gone leaving only the two strap muscles that come together at bottom of the neck in a V with the Adam's apple protruding more than usual. Deep in the hollow, a slow, steadily pulsating lift and fall under the skin is obvious, and Kimi guesses it is E's ebbing life force running down.

   E is 1.5 meter '(a little under 5 feet) length and 30 kilograms (66 lbs avoirdupois) of flesh & bone and much of the flesh wasted away by the cancer’s excess causing the skin to be tightly applied over the underlying bone and leaving E with a skeletal appearance. Sanya, next to and at level of E’s chest, pulls back the futon sheet cover and starts the examination.

34. Sleeper Wakes

E opens eyes and Kimi makes out E's black iris-rimmed pinpoint pupils.

   “Good day, Lady Professor”, says E in hoarse weak whisper. “How are you?”

   “I am well. This is the new helper, Miss Kimi.”

   E barely moves head and Kimi realizes that even the whispering exhausts her.
   Sanya briefly dictates to Kimi who scribbles down the data.

35. The Vital Signs

“Armpit temperature 37.8 degrees C. Normal is 36.5, plus or minus 0.5 depending on time of day. A fever typical of late cancer comes from the high oxygen burning in the tumor tissue and even though most patients do not complain it is better to treat it because the fever exhausts the little energy they have.”
   Sanya speaks a standing order to Helper: “Give 80 mg aspirin on a 4-hour prn”, which she explains to Kimi is from Latin pro re nata meaning “for an occasion that”, or “as needed” for a body temperature above 37.3. It is one quarter of usual body dose because E is so frail.

   Continuing, Sanya counts the breathing by rise & fall of chest. “Eight per minute, one half the normal rate for resting in bed," and then explains to Kimi, "and due to high dose morphine which slows breathing.”
   Turning to Helper: “Continue to give morphine as she wishes.”
   Addressing Kimi: “E and I discussed morphine. It is her choice to have it ad lib – that is Latin ad libitum, or ‘at one’s pleasure', repeatedly as she wishes."

   “Why morphine?” asks Kimi

   “Mostly for contentment because it makes one feel at peace with one’s body.”

   Sanya continues: “Blood pressure, eighty-five slash fifty-five millimeters mercury and heart rate sixty beats per minute.” And for Kimi she explains, “It is from the morphine's lowering blood pressure and slowing heart. It is good for E; it lightens the work of her weakened heart muscle.”

36. The Cancer-Ravaged Body

Sanya’s exam progresses to where E's full body is covered only by a sheet.  Sanya pulls the sheet back and Kimi notes E's almost flesh-less limbs and head, and her swollen abdomen. Below her knees the wasting is extreme, with only a thin layer of skin covering bones.

   Sanya examines by finger-tapping percussion of E's swelled abdomen, getting a low-pitched flat tone. “Tension ascites,” she says to the helper. “Prepare for a tap.”

   To Kimi, she explains, as the helper assembles the materials, “Ascites is excess fluid in the abdomen and it builds up tension because its rate of production exceeds absorption back into the system. It makes every movement in bed very painful, and when that happens I tap it with a needle to drain out the fluid.”

   The helper swabs E's abdomen with alcohol and she hands Sanya a five-centimeter length, wide-bore needle attached to a rubber tubing that leads to a bucket in a depression in the floor next to the bed. Everything is kept sterilized and wrapped for use. Sanya pushes the sharp of the needle into the abdominal wall in a fast motion, and clear amber fluid shoots back into the tubing and squirts out into the bucket below. Sanya instructs the helper to regulate the flow with a crunch-valve on the tubing and then to start a 1-liter bottle of intravenous fluid dripping into a vein in E's elbow crease. 
   She stands and beckons Kimi. As they go into the outer room she comments, “We must be careful not to remove too much too quickly because it is coming from the blood fluid and if we remove it too quickly we will send E into heart shock. So we take an hour and give 1 liter of intravenous saline solution.”

37. A Good Dying

They sit at table and Sanya begins about A Good Dying. “The ideal response relates to several factors – person, place, condition, environment. Here I delineate Person – intelligent and successfully psychoanalyzed – science self-education psy-analysis that allows one to understand what determines one’s behavior. The analysis when complete clarifies aim in life and reason to keep living or not.”

   “Having a guideline for one’s life is important in dealing with dying. Most persons do not have one; others substitute faith in religion that promises afterlife. It is a denial that can work in giving peace of mind for the unintelligent in an age of faith but not for most persons today.

   “The average person cannot emotionally see his or her approaching death and first reaction after the denial has been forced out by the dying process is depression. Many shrivel up emotionally and die quickly but most follow mindlessly the path society has paved – to become a mewling beggar after medical care." 

   Sanya asks rhetorically: “How might a successfully psychoanalyzed person deal with dying from cancer?"

   And answers herself. “Such a one is of necessity an adult past 40 because I cannot see a completed, successful psychoanalysis before that. This type would have a life goal and be already pursuing it so the learning of having cancer should enhance appreciation of one's life while keeping in mind, cancer or no, the fact that personal life consciousness is a limited, once-only precious experience.”

   “The plan should be to prolong enjoying life maximally, preparing successor and helping friend and family to cope with the dying process. Also with mastering what I call Endgame – the final stage leading to Exitus.

   “A good dying can only occur in a good social setting. I mean stability and close family or other companion to rely on. To be happily married or living with understanding, loving parental family is best because loyal, energetic helper is a key to a good dying. Without at least one other such person, a good dying is hard to achieve because at some point in the dying process one loses independence and if one has no loyal, able companion one is thrown back on the bad aspects of the civilization exposed to mentally disturbed, ignorant caregivers.

   “Creating stable, companionate, compassionate relationships ought to be a life goal. It means seeking out close person or persons who do not have a discordant philosophy, cultivating a close understanding family, and doing Seminar for family and companions to learn how to deal with dying.

   “In terms of Seminar, everyone who will be someone's life partner must learn that dying is not a time to create stress for the dying person. It requires complete faithfulness within the dying person's concepts. Thus in a sexually un-free society as we have, a spouse should not have a love affair or sexual affair. Similarly if one normally tends to get angry with one's spouse, one should cease that behavior. A dying person even intelligent and well psyched may become unreasonable and emotional and paranoid as she or he approaches Exitus, and since it may get out of control a mate must not respond, as she may have in past, in kind. Carry out all requests if possible and if not impractically unreasonable. Otherwise, turn the other cheek instead of becoming angry at unreasonableness or at abusive behavior. A good economic condition is a must for a good dying. In capitalist society, dying uses up too much money. Especially when one plans to die unorthodoxly, one needs money.”
   To read on, click 11.(38) Cancer 3 - How to Die in Japan