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Elizabeth Edwards made wise choice to go home

By Theresa Brown, Special to CNN
  • Theresa Brown: Elizabeth Edwards chose to stop aggressive treatment for cancer
  • Some equate more treatment with "fighting," see accepting death as defeat, she writes
  • Brown: At some point, treatment is just painful, invasive or degrading
  • Edwards made the wise choice, Brown says, to be home surrounded by people she loved

Editor's note: Theresa Brown is an oncology nurse in Pennsylvania. She is a leading contributor to The New York Times' blog Well. She is the author of "Critical Care: A New Nurse Faces Death, Life, and Everything in Between."

(CNN) -- Elizabeth Edwards died at her home after opting to stop all aggressive treatment for breast cancer that had spread to her bones and liver. The accolades for her hopeful, but realistic, fight against cancer are piling up, and they are well-deserved.

But it's also worthwhile to take a minute to look at the choices she made once she learned the cancer could not be stopped and that death was inevitable.

She chose to leave the hospital and go home. That in itself is remarkable.

In the modern lexicon of cancer, treatment is battle, and acceptance of death a kind of defeat. The phrase that recurs in these situations is "do everything," which means, use every possible medical intervention, no matter how invasive, painful or degrading, to stave off a death that regardless will come.

That's what death looks like in intensive care units. Patients are hooked up to ventilators and drips, with multiple IV lines and tubes inserted in every orifice, for the sole purpose of maintaining signs of life in a body that has irrevocably declined.

Edwards did not want that.

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In her Monday Facebook statement, she said, "The days of our lives, for all of us, are numbered."

She was known as a valiant woman, but that was perhaps the bravest statement she made, because in it she acknowledged a truth we Americans keep trying harder and harder to run away from: Everyone dies.

It's not an easy fact to contemplate, but it is true. So then the question becomes, insomuch as any of us can control the details of our death: How do we want to die?

Some people do not get a choice. Accident victims, soldiers and civilians in Afghanistan or Iraq, people in car crashes, people who have sudden and massive heart attacks -- death comes to them on its own terms.

But Edwards had a choice, and her choice was to be in her home surrounded by the people she loved, and to be comfortable.

Dying at home, surrounded by family

In end-of life discussions, "comfortable" can come across as a dirty euphemism for abandonment and defeat, but keeping dying cancer patients free from pain is a hard and serious business. When breast cancer spreads in the body, bone is the most common place it goes. It's hard to think of bone as living tissue, but breaking an arm or a leg hurts because our bones are very much alive. Uncontrollable, malignant growth in bone can be excruciatingly painful, especially if the cancerous growths impinge on nerves.

Palliative care medicine exists in part because managing this kind of intractable pain typically requires large doses of narcotics that need to be thoughtfully prescribed. The trick is to keep patients comfortable while not making them permanently somnolent, at least for as long as that tradeoff is possible.

Because I'm an oncology nurse, I have seen the pain cancer patients feel at the end of life. It is awful to behold. For family members, watching such suffering is agonizing. Even though they, and we, wish it not to be so, everyone in the room intuitively understands we are seeing the face of death.

So then we have a choice.

We can say "do everything," go to the ICU and rouse the troops for one last fruitless battle against death. Or, as loving family members and as caring members of the health care profession, we can acknowledge that making someone comfortable is the only beneficial care option remaining.

It's a hard call to make for our own lives, harder for someone we love, but for many of us the necessity of making that call will come.

Elizabeth Edwards and her family faced that moment and said, "Let's go home."

The opinions in this commentary are solely those of Theresa Brown.