European Stars And Stripes (Newspaper) - April 16, 1986, Darmstadt, Hesse Fateful Choice in fatal illness by Andrew h. Malcom new York times w Hen the 69-year-old Man entered the Hospital in Rochester n.y., recently rethought he had Only a Back he left for Home six Days later he had chosen to die. In Between he Learned he had a fatal illness and had to make the decision confronting a growing number of aging americans whether to prolong his life aggressively with medical machines and modern technology or surrender to the natural dying process very soon. The patient Call him Robert Anderson although that is hot his real name chose to give up. I want to go Home he told or. Richard b. Freeman a specialist he had met Only recently. Freeman leaned Over the bed and asked you understand what this decision Means Anderson nodded and then smiled. Freeman patted his patient s hands. And in a moment the two said Farewell. Decisions like Andersons once left to Fate have become commonplace in a rapidly changing Era of Medicine where machines can prolong life often beyond the will to live it. These situations pose delicate ethical and moral questions for families and for the doctors who must Lead them honestly but sympathetically through this emotional and painful time. As growing numbers of patients and relatives Are discovering it is one thing to discuss in the abstract what medical treatment to accept at some future time. It is quite another to face that decision one Day in a Hospital bed when the consequences can be almost immediate and final. These delicate discussions Are filled with pressure euphemisms pregnant pauses sports analogies even a Little humor anything to avoid using that word death. And rarely do any details of those tearful talks leave the Ward s or the private meeting rooms where patients their husbands or wives sons and daughters Brothers and Sisters help decide in effect when a seriously ill loved one will die. In the Anderson Case the patient doctor and Hospital allowed a visitor to attend such discussions. When the 54-year-old Freeman first encountered Anderson the patient had undergone surgery at a Rural Hospital for a disc problem. But doctors there were uneasy about How to treat such an unusually High Calcium level in a patient s blood. Freeman a kidney specialist at Strong memorial Hospital of the University of Rochester had his suspicions though he said nothing to the patient. The doctor ordered a Battery of tests a rays and other examinations. He consulted with several other doctors who examined the patient and pored Over test results. The a rays were even used As a teaching tool in a group discussion one lunch hour. The results however were unavoidable. Anderson had so Many cancerous tutors in his body that they were rapidly dissolving his Bones. Hence the High Calcium level which in itself could prove fatal if not controlled. Freeman has Learned Over nearly three decades that patients do not fully listen when he routinely notes How Little doctors know about so Many things in the human body. They re often frightened he says and they want you up on that omniscient he has also noted that when confronted with too much bad news patients and family often become confused and forget key Points. So he eases into talk of terminal situations with generalities. You avoid words like cancer " the doctor said. You use gentler words with the same meaning like tumor you never want to crush All Hope even if it s just Hope to die with dignity because i be seen some hopeless cases turn around. And you never find out the shifting ambiguous line Between doing everything medically possible to prolong meaningful life and doing no More than necessary for Comfort to avoid prolonging the dying process is not universally taught in medical schools. The degree of aggressiveness of treatment is often left to the accumulated experience and Basic personality of individual doctors and their consultations with Peers As Well As the patient and family. For Many doctors fearful of charges of malpractice or worse in a litigious society a patient s death can seem a professional failure and every Means must be used to postpone it even in Clear Cut cases of terminal illness and sometimes against a family s wishes. However hospitals generally have a do not resuscitate or "d.n.r.," Sheet a list of seriously ill patients whose families agree they will not be actively resuscitated should the heart or lungs fail. I took the hippocratic oath to do no harm " Freeman says. And we must always be careful. But i think with All this medical technology at our disposal today we can often do harm by using everything every Freeman had a cup of Coffee before entering the patient s room that morning five Days after meeting Anderson. Hello Freeman said. How re you feeling i m not off to a very Good Start today said a Pale Anderson. My Bones Hurt a us huh said the doctor. Well you be been poked and probed a Good Deal you la have to speak up said the patient. My wife s hard of hearing and so am that s right said mrs. Anderson. Don t blame it All on and the Trio chuckled. Freeman raised the volume of his voice a notch. Ill be As straightforward and honest As possible with you he said. You said you wanted that. I have a feeling you already know what s going on in your body but let me Tell you what we know and you can begin to think about what we do the doctor chose his words carefully using pauses and firm gazes to emphasize the seriousness of his words. He outlined Anderson s medical history the Back operation and the lethal Calcium problem. Now Why did this happen asked the doctor. There Are Many holes in your Bones. Some of your ribs Are broken. There Are lumps on your kidneys and bladder and lungs. These Are tutors. And they re spreading. You kind of thought that did t you new York times photo or. Richard b. Freeman examines an a Ray Anderson nodded. Can we do anything the doctor continued. Maybe. We Don t know yet what kind of tutors these Are. There Are hundreds of kinds. A few respond to treatment. Some go he paused. Others we can t do much he paused again. Well be very honest with you about the Outlook he went on. But i won t have All the information for a Day or so. Any questions you knew it yup. Keep right on it i will but Are you a football fan Well it s fourth Down or. thank you very much i Don t know the doctor said softly if thank you is the right thing to what did you say Doc nothing said Freeman. Ill be Back on the patient s Chart Freeman noted the conversation and added family and patient still have some Hope. Pis do not give final negative prognosis yet. Perhaps Tonitte or that afternoon Freeman telephoned the cancer specialist a woman he knows Only by sight and reputation. The two doctors needed Only 85 seconds to agree that the cancer was too widespread for effective treatment and that Anderson had perhaps two months to live. The cancer doctor thought radiation might ease the Pelvic Bone pain. But they knew that within two or three Days this would increase the Calcium level producing a foggy consciousness and then a sudden heart stoppage. The doctors also agreed that Given a Choice of two months cancer pain or a few Days of grog Giness each would choose the latter. That evening when Freeman returned to Anderson s room to continue the grim prognosis the patient was dozing. Of Good morning doctor said a glazed Anderson. How Are you today nurse said Freeman what have you got him on the answer was morphine his pain had been too great. So much for rational discussion this evening said the doctor. The next morning Anderson was Alert. I be talked to the oncologist the doctor said. We can Only treat some of this pain with radiation. That will the Calcium. And then we can clean your blood every couple of Days with an artificial kidney. But you might find this a miserable prolongation of things. I m afraid things Are not going to improve. The Outlook is us Well the two minute warning is i understand said the Man. We be talked about it. And i want to go Home. I appreciate everything you All have done. It s been the greatest care in the i wish i could do More said the doctor. Me too said the Man smiling. It s a very poor Deal. But i la try to put some More Points on the i m sure you and the doctor kissed the Man s forehead. I m sure i la see you again said the patient. But the doctor did not respond. Outside the room he spoke to mrs. Anderson. I Don t want to give you any false Hopes he said. We re talking a few Days to a i thought so she said. After arranging the immediate Transfer Back to the Rural Hospital and consulting Anderson s doctor there a grim Freeman walked Down the Hall past some laughing visitors. I Don t know what s right he said. I just do my that was on a thursday at noon. Sunday morning at the Rural Hospital about three hours before Dawn Anderson s heart stopped. He and his wife had agreed to a do not resuscitate order. When the alarm sounded the nurses did nothing. The death certificate said Robert Anderson died of cardiopulmonary Page 14 the third sex today s professional woman by Iris Krasnow United press International Strong aggressive Independent smart. Typically male try 100 slowly Chipping away at a Man s world professional women in America have shattered gender roles to emerge As new creatures described by anthropologist Patricia Mcbroom As the third sex the title of her new Book. It s a new gender that women have been creating since the 19th Century when females started to move out of the Domestic sphere and into the male work Domain says Mcbroom 45, an adjunct professor in the women s studies program at Rutgers University. Based on the testimony of 44 women in High finance jobs Mcbroom s Book concludes that qualities traditionally linked to the feminine ethos sexuality sensitivity time to play willingness to care for other people. All become casualties of making work the most important thing in life for the new woman who is trying to have it All. I really came to the conclusion that the majority of women in professional Fields who Are postponing an insecure Man can t handle a powerful woman. But to make it a gender Issue is to look at it Cross eyed. Confident women also attract confident women marriage and not having children Are not making those choices completely willingly Mcbroom says of her Book. Professional roles As they Are presently conceived threaten female other High achievers untapped by Mcbroom agree that indeed the sacrifices can be great but that the third sex if there is such a thing is satisfied in her new status. I Don t feel i have compromised my personal life to get where i am says Julie Archiletti director of government affairs for Occidental chemical corp., which boasts $2 billion in sales a year. She is 32 and single. I Don t want to be married just for the Sake of being married. I would rather be alone. Eventually i would like to have children but i m not dying because i m not having them because mainly i enjoy what i m doing and the Confidence i be developed. To sometimes scares Guys off she admits with a laugh. It makes them aware of what they Are a clinical psychologist or. Fern Loos 36, says if a Man gets shaky when he s with a Strong woman it s not the woman s place to worry. Most of the powerful women i know attract powerful men says Loos whose practice is based in Washington. An insecure Man can t handle a powerful woman. But to make it a gender Issue is to look at it Cross eyed. Confident women also attract confident women Dpi photo work is not the Center Force in my life says Laramie Faith Mcnamara 39. Loos will be married for the second time in july to a very powerful and wonderful Florida executive who is changing jobs and moving to Washington to accommodate his wife to be s flourishing practice. She says that achieving a Slot where she commands a six figure annual income has t meant giving up her femininity but rather using it As an asset. My femininity has been a huge Boom to me. I use typically female things like intuition and flirting to get what i want and i use them in a powerful other women interviewed also have an evolved perception of womanhood and that definition stretches to traits previously considered Manly. Assertiveness aggressiveness a sense of dedication to work directness this is All part of being a woman says a 33-year-old partner of Lurie Sklar and Simon ltd., a Chicago Law firm. Another woman of accomplishment confesses that climbing the ladder has meant giving up a lot of things. Ill be honest. I would have loved to have a family and i think i sacrificed that in order to do what i wanted in my career says Laramie Faith Mcnamara 39, manager of Federal government relations for the $6 billion a year try co. At 35, she married a divorced Man with two grown children. I Don t think Well have any More children says Mcnamara. It would be very hard to spend As much time at work developing the Quality of product i expect from myself and dedicate time to she takes exception when it s suggested her life has taken on a narrow focus at the expense of important other needs a trend suggested in the third sex. Work is not the Center Force in my life. There is a balance says Mcnamara. In my private life i take care of my caring and nurturing parts. I m on the Board of directors of an organization that deals with the mentally ill. I find a lot of emotional release in american society s acceptance of the new woman is expanding along with her enhanced sense of self according to Elisabeth Hanlin director of state and Federal affairs for Sperry corp., a $6 billion a year High technology firm. Now there is More of a blending of the gender roles says Hanlin the Mother of two College age boys. People Are not so Quick to categorize various activities As being male1 or female " Mcbroom says men can still make snap judgments about women but the difference now is that women Aren t threatened by it. Strong women Are inevitably setting a new Standard of femininity on the Job front she says. It s not that these women Are a feminine. It s that the old concept of femininity is being recreated and the new definition includes the stars and stripes wednesday april 16, 1986 the stars and stripes Page 15
