Five Stages of Dying

Several moments from the hit TV series House M.D. the philosophy of helped me hold myself together during the last one month of mother’s approaching death. Particularly Episode 1 of Season 2, Acceptance.

A young woman in her 30s visits the clinic for some routine tests for her health clearance certificate for a new job. Dr Cameroon greets Cindy, takes a look at her chest X-ray report and a slight hint of worry comes across her face. In the next scene we see her consulting with Dr Wilson, Head of Oncology. Dr Wilson tells Dr Cameroon with a grim face, “You don’t need a consult. You know the diagnosis.” “All she has is cough,” tells Dr Cameroon in bewilderment.

It turns out that Cindy was terminal and there was absolutely nothing that could be done, and yet in terms of symptoms all she had was cough. This was exactly my mother’s story, all she had was cough. We thought it was no more than a viral fever. Maybe a bad infection.

Dr Cameroon wasn’t ready to accept the terminal diagnosis and asked Dr House to take a look at the case but he refused. Instead, to make his point, he wrote on the wall the five stages of dying for terminal patients.

five stages of dying house md 2

Denial
Anger
Bargaining
Depression
Acceptance

As the story progressed it was observed that instead of the patient it was Dr Cameroon herself who was going through the five stages of dying. In my case it was me instead of my mother.

When the PSRI doctor told us that the pleural effusion in her lungs were malignant my first reaction was denial. yeah right of course they are deliberately showing false positive result so that we go for unnecessary tests like biopsy and PET Scan.

From denial, I moved to anger when I thought PSRI was wasting time, not treating her so I must move her to a bigger hospital.

When the second cytology report also came positive for malignancy, I started bargaining with destiny, pray it be breast cancer, as it has higher survival rate. Let it be that rare gene mutation type so that Table Erlotinib works. Give us 8-12 months. Give us 3-4 months.

Depression and acceptance happened after her death, but mother never went through these. She just stayed calm and positive all through.

Dr Cameroon eventually does a biopsy and reaches a conclusive diagnosis that it is indeed terminal cancer. But she was unable to break the news to the patient. In one scene we see Dr Cameroon talking and laughing with Cindy. Dr Wilson approaches her and tells that its not her job to make friend with the patient. “She feels a little better in her final days but you are not the same anymore for days. Maybe years,” says Dr Wilson and insists Cameroon not to get emotionally drawn towards the patient.

I recall now that I have been upset with my mother’s oncologist because he wasn’t meeting her towards the last day of our stay in BL Kapoor hospital. But I understand why. Those doctors are humans, they have to do what it takes to keep their minds in the right place. My mother loved and revered doctors the most in this whole world. More than soldiers who defend borders, more than scientists who invent stuff. She would always scold me if I showed disrespect towards the doctors.

After we told my mother that she had cancer I asked her, “Ma don’t you feel angry at the doctors. You have been regularly visiting the doctors but such a disease entered your body and nobody had a clue. I have lost faith in doctors.” She said, “Well then if losing faith in medical science is the solution then why keep me here at doctor’s hands, take me home to die. That is the nature of this disease what can doctors do?”

My mother’s faith in medical science betrayed her the most. But she had not a shred of fear, doubt, anger, depression in her mind.

The episode also showed a clash between Cameroon and House as House refused to even look at Cindy’s case and rather put all his time and energy in treating a murder convict on the death row. This infuriated Cameroon. For her, Cindy being a good young woman deserved at least same attention if not more than a death row guy. But to House it made no difference. “Cindy is dying, no matter what we do,” said House to make the point that doctors often have to prioritize resource allocation as per not who is a good person but who has a chance of survival.
This was exactly the reason they repeatedly asked us to take my mother home and not occupy a bed because mother had no hope. She was terminal and barely had few weeks to months.
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