Hospice: The Lesson
By Joan Morris
TIMES STAFF WRITER
Published Sunday, May 20, 2001, in the Contra Costa Times Newspapers.
Orginal Link Addresses:
SFBAPPA.ORG Award of Excellence:
Bob Larson, Contra Costa Newspapers, "The Lesson" - Corresponding Photos.
CHAPTER I: Giving In, Not Giving Up
Choosing to live life to the end with hospice
By Joan Morris
TIMES STAFF WRITER
In many ways, the images on the screen are hauntingly beautiful.
Diane Sheffield stares up at a smoky silhouette of a skeleton, a photographic doppelganger of the bone scan she underwent earlier. The radiance of the images momentarily distracts her. She has seen bone scans before, but never one like this.
The bones show charcoal gray, but throughout the images are spots of white, scores of what appear to be neatly drilled pinholes.
Like holes in her soul, Diane thinks.
Even if Diane hadn't instinctively known the horror the scan reveals, she would have surmised it from the reaction of the nurse.
The breast cancer she has fought so hard has returned with a vengeance, metastasized to the bone. The holes are tumors, and they are everywhere: the thigh bones, the spine, the skull.
"One of the nurses that I'd become close to burst into tears," Diane says. "I hugged her and told her 'We'll go for broke.'"
On that day in December 1997, Diane has every intention of fighting and winning another battle against the cancer. She did it once before, in 1989 when -- maintaining a full work load as a high school counselor -- she underwent a modified radical mastectomy and opted for both radiation and chemotherapy treatments.
The intervening years haven't weakened Diane's desire to fight. She is only 57 years old. She wants to live. So Diane signs up for a new round of chemotherapy and prepares for what she knows will come: the exhaustion, the hair loss, the sickness.
But this time, something is different. There are complications. In addition to all the other side effects from the drugs, an infection almost kills her. The port that doctors had installed in her chest to more easily feed in the cancer-killing drugs, instead provides an avenue for infection. The venous access port is removed, and Diane spends several days in the hospital, recovering.
The treatments and the infection leave her so drained and ill that she is forced to retire from teaching, a career she had planned for her entire life.
And yet, little she does seems to make a difference.
The chemotherapy slows the cancer from the dead run of a sprinter to the paced gait of a marathoner, but still, it advances. In August 1998, the Tumor Board at UC San Francisco rejects Diane as a candidate for bone marrow transplant, considering the cancer too far advanced for the treatment.
"I finally said I'd just as soon stop treatment," Diane says. "There was no sense in going on."
Diane breaks the news to her family. Her husband, Bob, manages power for Gaylord Container in Antioch. Bob, a trained engineer with an engineer's stereotypical preciseness, is a quiet man who asks very little from anyone.
Bob and Diane both have strong wills and their own opinions on how to do things. It is a combination that shouldn't work, but does. They don't always agree with each other, but they support each other's decisions, and Bob stands firm behind Diane's desire to halt her treatments.
Their sons, Robert and Daniel, are numbed by the news. The cancer has spread beyond a cure and now it is time to think about how she will die, Diane tells them. She wants to stay at home. She wants hospice.
Diane, who has spent more than 30 years as a teacher and counselor in Contra Costa high schools, has researched hospice.
She knows all about Hospice and Palliative Care of Contra Costa, which will allow her to be in control of her final days. Nurses, volunteers, chaplains and social workers will come to the Walnut Creek home where Diane has lived for more than 30 years. They will help her with her pain and with her spiritual uncertainties. They will come when she wants them to, and they will do nothing that she doesn't want. It's a bond that hospice programs make with their patients.
Robert, an orthodontist, grimly accepts the move as inevitable. Hospice is what Diane wants and that's what they'll do.
Daniel, the younger son, is more uncertain. He is angry -- not at his mother, but at the cancer. He wants a solution, a cure. But he knows his mother, perhaps better than his brother and father do. And it is her confidence that hospice is the best choice that sways him.
Breaking the news to friends is much harder. Diane, born and raised in Antioch, has friends she made in the sandbox. They know her as painfully organized and determined. The news that she is going into hospice doesn't fit with their image of Diane as a fighter.
"Some people have said, when they heard I've started hospice, 'My God, Diane, you've given up.' Given up? Given up life? What is this, Lent? There is a difference between giving up and giving in. I was giving in. I wasn't giving up."
Hospice will help her manage the pain, and more importantly to her, it will help her family cope with her death and their grief. She will be able to die on her own terms.
So when people shake their heads and tsk-tsk about the "poor doomed woman," Diane looks them straight in the eye and tells them to wise up.
She is 57 years old and she is dying.
"Medicine can't help me anymore, so I try to live life to a fullness. Maybe it's a different fullness, but I'm still able to do things."
She is on a journey of death, Diane says, and on a journey for life.
Tomorrow, Chapter 2: Choices
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