A Lesson Before Dying

When I moved to Newton in the summer of 1997, Tom Menino was already in his second term as mayor of Boston. His accent was so strong, his enunciation so mushy, I think I could make out every 4th word Menino spoke. Sartorially speaking, he appeared rather rumpled, or, in Yiddish, a little shlepidik. Whatever the opposite of glamorous was, it was him.

Years later, even though I’m a citizen of Newton, I’ve followed Menino and his style.  His intense up close and personal style always appealed to me as did his no nonsense roll your sleeves up and get involved attitude. I’m not saying the man was perfect – I am saying that Tom Menino’s can-do attitude and his work ethic inspired me. I was and will always be proud that he was my “other” mayor.

In his later years in office, Menino endured stretches of poor health, including two earlier bouts of cancer. Every time Menino managed to battle back to good health. But when he was diagnosed with aggressive cancer shortly after he left City Hall, it felt truly tragic. He’d worked so hard, he’d earned lots of free time to spend it with his family. And now he was being cheated.

Today Tom Menino informed us that he was suspending chemotherapy. He’s done. I must say that I, like so many in the Boston area, felt a sharp pang of regret and sadness. He’s a father figure, an institution. People like Tom Menino are supposed to be indestructible. But they’re not. And we’re not either.

Tom Menino had come to understand that his cancer treatment would not, could not bring him a quality of life worth living, and so he said no more. What a brave declaration to make!

Our society has created the expectation that anyone with cancer, no matter how advanced or how debilitating, has the obligation to keep getting treatments, no matter how debilitating or how miserable. The option to say no more has been characterized as dishonorably surrendering to the enemy. A cancer patient isn’t allowed to ‘give up.’

In a world where it seems de rigueur to keep trying the latest chemo or the more extreme dosages despite the massive side effects, it feels like our lives don’t quite belong to us. It often seems to patients and families that the docs and the hospitals aren’t looking at the entire picture. It’s as if the endgame is a different issue. But of course, it’s not. The endgame, after all, is the place where we all arrive.

Doctors have begun to reassess the ways in which sick people are pushed to treatment. They have begun to acknowledge that it can be cruel and futile to operate on elderly, enfeebled people. They have begun to engender a sea change in Western cultural expectations about embracing palliative care and hospice not as failure, but as in lifting up end of life care as gentle and kind.

Atul Gawande’s newest book, Being Mortal,  looks at the issue of dying well in America and the impediments to achieving it. He pushes us to see that living a long life for the sake of living, despite pain and the loss of autonomy and dignity, must be discussed openly. Tom Menino decision challenges us to discuss this, too.

Our tradition reminds us that while we are forbidden to hasten death, we are also forbidden to stand in its way when death is imminent. The fundamental Jewish value, choose life, is exactly what Menino did when he said no more to his doctors. By ending chemo, by commencing palliative care, he is dying on his own terms.  I read that as choosing life.

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