Alzheimer's vs. Cancer

cnorman18 · Post by **cnorman18** » Mon Mar 30, 2009 10:42 pm

As many here know, I make my living as a caregiver for the elderly. I am the alternative to the nursing home; I help my clients live out their last days with dignity, in cleanliness and comfort, in their homes. Since I began this work a few years ago, I have been present at the passing of five of my clients.

My current client is an elderly man with, at this point, moderate Alzheimer's disease. That is a one-way road, and it gets pretty dark toward the end. Patients in the last stages are often constantly terrified - every place is a strange and frightening place and everyone a stranger to be distrusted and feared. It's a very, very hard way to go.

That prognosis is difficult enough for his family to deal with; but he also has terminal cancer. It is "treatable, but not curable." Chemotherapy will extend his life to some degree, but at the expense of some discomfort, which may grow worse with time.

The dilemma should be obvious, but to spell it out: should he undergo treatment, or not?

Life extension, when one has Alzheimer's, is a mixed blessing; if it involves additional pain, it is even harder to contemplate. Would it be kinder to allow him more time with his family before the disease grows more debilitating, and risk possibly extending the suffering of that terrible disease? Or to allow the cancer to take him before he is living among strangers?

I am grateful that this decision is not mine to make, but as often happens, I have become an adjunct member of the family and am there for many of the discussions. It's hard to watch. The consensus thus far is to proceed with treatment as long as he tolerates it well; so far, the side effects have been mild and not painful or difficult for him. If it grows harder, they will stop the treatment and let nature take its course.

We are only at the beginning of this journey; he is beginning to come "unstuck" in time, occasionally unsure if he is at home and who his wife (of almost 50 years) is; but most of the time he's still pretty well connected. The cancer is not yet giving him discomfort. Both will gradually grow worse.

I just wonder how others would answer this question. I don't think that religious questions are particularly important here; the question just seems to me to be, what's the right thing to do? It seems to me that the family is making a good and reasonable choice.

Any thoughts?

Goat · Post by **Goat** » Mon Mar 30, 2009 11:30 pm

20 years from now,I might have a different answer, because the state of medicine when it comes treating Alzheimer's would be much better, but it seems to me that delaying cancer would just bring more pain and misery to everyone concerned.

I would rather go sooner, with my wits intact. I think i would rather keep my loved ones from seeing me fall to pieces.

cnorman18 · Post by **cnorman18** » Wed Apr 01, 2009 8:56 am

goat wrote:20 years from now,I might have a different answer, because the state of medicine when it comes treating Alzheimer's would be much better, but it seems to me that delaying cancer would just bring more pain and misery to everyone concerned.

I would rather go sooner, with my wits intact. I think i would rather keep my loved ones from seeing me fall to pieces.

Thanks, Goat. That would be my call as well.

He had his third chemo session yesterday. They come every 3 weeks. After the next one, the family and the doctor will be reevaluating. The ironic part is that from where I sit, it looks like the chemo is slowing the cancer but accelerating his mental deterioration.
I'll keep you posted.

JoeyKnothead · Post by **JoeyKnothead** » Sun May 03, 2009 12:11 am

goat wrote:20 years from now,I might have a different answer, because the state of medicine when it comes treating Alzheimer's would be much better, but it seems to me that delaying cancer would just bring more pain and misery to everyone concerned.

I would rather go sooner, with my wits intact. I think i would rather keep my loved ones from seeing me fall to pieces.

Just to add my voice to goat's take here. I personally hope I am able to control my death. I don't want either Alzheimer's or cancer to be my fate.

If my father were in this state I would let nature take its course.

Intrepidman · Post by **Intrepidman** » Sun May 03, 2009 1:25 pm

I don't see a dilemma. If it was me, and I had Alzheimer's I would pray for an aggressive cancer or something to take me quick before it got too bad. It's a quality of life thing. I would consider the cancer a form of euthanasia.

Seriously, Alzheimer's would be way on the bottom of my list as ways to die. Losing your mind, yourself, and being a total burden on those who love you.

cnorman18 · Post by **cnorman18** » Mon May 04, 2009 1:13 pm

Update:

My client's family has decided to terminate the chemo treatments as of today. They have been more difficult for him of late - interfering with his enjoyment of food, etc. - and he has been growing more mentally impaired as well.

This was not my decision to make, but I concur with it. Thanks for your thoughtful responses.

Goat · Post by **Goat** » Mon May 04, 2009 2:56 pm

cnorman18 wrote:Update:

My client's family has decided to terminate the chemo treatments as of today. They have been more difficult for him of late - interfering with his enjoyment of food, etc. - and he has been growing more mentally impaired as well.

This was not my decision to make, but I concur with it. Thanks for your thoughtful responses.

I give my best wishes to your client and his family.. and hope that the best quality of time he has left is achieved, with the least amount of pain.

cnorman18 · Post by **cnorman18** » Mon May 04, 2009 3:11 pm

goat wrote:I give my best wishes to your client and his family.. and hope that the best quality of time he has left is achieved, with the least amount of pain.

Thanks, goat. I appreciate the sentiment.

I'll keep everyone posted on this thread.

Bio-logical · Post by **Bio-logical** » Sat May 30, 2009 3:15 am

I also work in long term care and I hope to never need the kind of care that I provide. If I can go mercifully earlier than I become unable to care for myself, I would be happier than extending my life for any reason. I see no problem, for the record, in voluntary euthanasia - it is what I would want.

My grandmother has severe dementia with early stages of probable Alzheimer's and her quality of life deteriorates constantly even though her body is perfectly healthy. Most likely she will live another 10 years without recognizing her friends or family and in the moments she can she will continue to reminisce about embarrassing or otherwise inappropriate stories from 25 years ago. If she knew before her mind started to go what the rest of her life would be like, I believe she would have voluntarily ended her life with her husband's .

cnorman18 · Post by **cnorman18** » Sat May 30, 2009 9:28 pm

Thanks for all the kind words and comments, all of which I agree with.

Update: after chemotherapy was stopped, it was determined that it was ineffective anyway. My client's appetite has returned, and he is no longer suffering any side effects. He continues to deteriorate mentally, but slowly; his quality of life will, I hope, remain relatively good for some time to come. No word on how long he has; too soon to make that estimate. The cancer is moving slowly too. The family - and I - rather hope that it wins this race, but for the moment all are doing pretty well.

Again, thanks.

C

Debating Christianity and Religion