Ludwig Heinz - Live right, live longer

I nodded.

She responded well to the therapy. Again and again, she emphasized that under all circumstances she would have to hold out until her daughter’s graduation. I wished it for her and her daughter, and I thought it was possible from a medical point of view. Six years, that was two to three years longer than the statistical average in her situation.

Time passed. Martha Allen’s daughter, whose name I now knew was Sophie, was a reasonably good student. Without major problems, she moved on to the upper high school levels, successfully passed a make-up test in Latin, and finally reached her senior year.

Around this time, Martha Allen stopped stating her life goals. I got word that Sophie passed her final exams and then went on graduation holiday to Gran Canaria with her class. I asked myself what this event might have triggered in Martha Allen, but she did not speak to it just then and I did not ask.

Not until the autumn of that year did we talk about it again. Martha Allen told me that Sophie wanted to study biology and environmental studies. "I want to be here when she gets her Master’s degree," she said. "After that, I can leave peacefully."

I smiled.

"Don’t worry," she said. "Sophie won’t dawdle in her studies. She has become very purposeful in the past two years."

Could well be she has that from her mother, I thought.

"Eight semesters," said Martha Allen. "That would be another four years."

She said that in a jesting tone, but I could see in her eyes how serious she was. She did not even ask me if I thought that was possible. "What was that again about average values?" With an amused smile, she answered the question herself. "Averages are just averages, right?"

I do not know whether Martha Allen counted the years, I myself did not. One day I found an invitation to a Master’s degree party in the mail. Sophie Allen had completed her studies in the minimum period of time.

I went to the party and saw Sophie there for the first time. She was a tall young woman, elegantly dressed for the occasion, and often at her side was an even taller young man.

Martha Allen came to stand next to me as I studied the two of them. "A good-looking pair, aren’t they?" she said.

"Yes, very. Looks serious," I said. We exchanged a glance. I suspected that Martha Allen had found a new life goal. She presumably wanted to hold out until her daughter was married. We both laughed, because it was clear to us that we were thinking the same thought.

"It can be less than the average, but also more," she said. "You told me that at the time of the diagnosis. Would you tell me again what that means exactly?"

"That it can be a lot less," I said, "but also much more."

She smiled gratefully. She had aged since then, and her illness and the treatments had doubtless contributed a lot to that. But she still radiated some of that energy. "Well, much less is no longer possible now," she said. "Then it can only be a lot more."

A few days ago, as I write this, I received an invitation to the wedding of Sophie Allen. I will also be attending this event and hope that the young couple will soon have children. Then Martha Allen will be able to set a number of new life goals, motivated by her love and the strong feeling of being needed.

Postscript:

Unfortunately, Martha’s disease became resistant to hormone therapy, which required initiation chemotherapy, to which she initially responded remarkably well. But as time passed, the treatment had to be changed because the disease progressed with the development of liver metastases. Although second-line chemotherapy induced considerable tumor regression, it was becoming clear that her life span was nearing its end. But she did not leave before her daughter gave birth to her grandson, whom she was able to hold in her hands with deep joy and love after his birth. A few days thereafter, she was ready to let go and passed away in the evening with a smile on her lips after her young family had visited her.

The first time I saw Robert Tucker, he was sun-tanned and elegantly dressed. On second glance, I noticed that he colored his still full hair. Eighteen years earlier, at the age of 49, he had immigrated to the United States and gone into the real estate business, having earlier had business connections there. He impressed me as having been quite successful, although I also had the impression that he had invested in an expensive life style rather than providing for old age.

Mr. Tucker had lived a good life, so much was certain, enviably free and often exciting, with friends who lived as he did. In any event, that is how he described it to me. The years went by, his youth was gone, the greatest part of his life was behind him. Now he had colon cancer with metastases in the liver.

Robert Tucker regretted nothing. He had lived his life the way he had wanted to, independent, aware of what he was doing and also of what he had given up. He had always been ready to make his decisions clearly, soberly, and without illusions. He had done that, too, when local doctors had informed him of his illness. He had returned to his native city, Vienna, which many patients in his situation do when they have this possibility.

There were practical reasons for this. Mr. Tucker’s health insurance in the States cost about $10,000 per year. In addition, there was a deductible of 20% for every treatment. As the medications needed for a chemo-immunotherapy cost about $100,000 per year, the deduction plus the insurance meant a personal outlay to begin with of $30,000. The costs for a hospital stay, for the necessary tests, and for carrying out the treatments were in addition. For a self-employed person without major financial reserves this is not a very pleasant situation. I, for my part, could well understand Mr. Tucker’s decision to return to the health system in Vienna, where he had continued to be insured and would at least not have to worry about financing the treatment costs of his illness.

I suspected that he had already been soberly informed about his survival chances and his life expectancy. In any event, we did not talk about either, and we began treatment immediately. A part of this was chemo-immunotherapy, administered every three weeks, so that he could fly overseas between-times. However, the treatments lost their effectiveness relatively quickly. At some point he decided to stay in Vienna, as he was slowly losing strength and had developed a metastasis in the spine, which, after having been treated successfully with radiation, began to grow again and to be painful. We inserted a catheter into the spinal cord in order to initiate continuous opioid treatment.

After a few weeks he asked me for a confidential conversation. »Quite honestly,« he said, »I would like to end it.« He said that every additional day was just an additional burden, and the prospects were not good.

Mr. Tucker had no one outside of his care team with whom he could speak about these things and share his fears and worries. Even those of his overseas friends who were close enough did not come to Europe to see him, and had they in fact come, they would not have been able to stay for the duration to give him support on his final path. Occasionally old Austrian friends visited him, although his contact with them, as far as I could tell, had cooled in the interim.

I told him that his charming personality made him a particular favorite of the team on the ward, quite apart from the fact that in line with our credo we would, as for every other patient, make every effort to attain the best possible outcome for him. Both of these statements were true, of course, but it was clear to me, too, that as motivation to continue to fight it was rather thin. He left it at that, doubtless rather out of consideration for me than out of a newly-found will to live.