Waning

Thursday 7 June midday

Lara is clearly fading, her strength diminishing. She lies in bed mostly asleep. While awake, she wants to exercise her clarity of mind. That, too, will come under strain soon enough.

How so?

Terribly hard to say. This morning we had professor Schroyens over for a half hour visit, a man with an impeccable record as a hematologist and oncologist, and with impeachable bedside manners. From having read her file and from his own observation, he estimates that the end will come within a few days to a few weeks. He cannot be more precise. Loss of consciousness or awareness will come sooner. Life, he said, will be snuffed out gradually; she will go softly, like a flickering candle.

We discussed about transfusions. Friends and relatives are tormented most about this aspect of her demise. Why is she giving up? Lara is a fighter. Make her do battle!

Schroyens made clear that receiving transfusions is not going to prolong her life! She has cancer; it will run its course. Transfusions will improve the quality of life; give her comfort. Many people seem to believe that fresh blood will make her live longer. It will not. What transfusions take out of her are twelve hour days arond a trip to the hospital, plus one full day of recuperation, each time, once a week. Lara found that to be a waste. Not worth the investment. Schroyens agreed that the best way to proceed was the way Lara had chosen. He predicted her death to be serene and explained to her in detail what to expect, and what not to be afraid of.

He underlined that her blood values are very poor. An HB level of 5.0 is already very tenuous. The downward curve will soon start to have an effect on her awareness. How long it will take afterwards for her to pass on, depends on how her organs take the poor blood quality, notably the heart and lungs. She will not suffocate, he assured her. He didn't see any reason to change any element in her treatment.

Your hearing will go last, he said. He recommended we keep music on the whole time, rather than the wearing drone and gurgle of the oxygen machine.

Was she afraid to die, he wanted to know? Yes, a little, Lara replied with understatement. Death is not my favorite condition; but neither is the condition I am in now, Lara told him in Dutch. I am more afraid of dying than of death. I have never been dead before; I am ambivalent. Of course, you are, Schroyens said.

Lara made the point that she doesn't believe in God or a life hereafter. Would that make it easier for her to die, or more difficult? The doctor answered that as part of his profession he had seen many many people die. Most of them, by far, went easy. Two did not, he recalls, and they were the two strongest believers among all of his patients. Without prejudice.

We had just sat down for breakfast when he came. After he left, we finished our cappuccinos and Lara took a few bites of her soya yoghurt cum apple. Forget chewing, Schroyens had said, it is too tiring. Only fluids. Do soups or milkshakes. We will.

Lucidity is precious to Lara, up until her last breath almost. She is innately afraid of turning into a blithering idiot. Last night the codeine in her cough syrop (a morphine derivative) got to her, though. Even though her morphine level intravenously has been lowered to 10 mg/day, the cough suppressant gets to her quite directly. Lying next to her, I had to gently explain where she was and how she had gotten there. "I am not making sense, she said, and I hate it!"