Minnie Marshall isn’t sure how much time she has left.
The small-cell lung cancer she was diagnosed with two years ago has spread, causing tumors to grow on her pancreas and in other areas of her 55-year-old body. The same cancer killed her 53-year-old brother a few years ago. He only survived eight weeks after his diagnosis.
While the amount of time left may be unknown, Marshall does know one thing: she’ll die comfortably in her own home.
After three brutal rounds of chemotherapy and radiation failed to stop the cancer from spreading, Marshall made the decision to stop curative treatment and in July called Community Home Health & Hospice in Vancouver.
Now Marshall focuses on managing her pain and enjoying time with her daughter, rather than undergoing painful treatment that won’t stop the cancer, only prolong the inevitable.
“I’d rather feel healthy in my time left than create artificial time,” Marshall said.
Marshall was working on her master’s degree in social work when she got sick. She interned at an adult day care facility, which sparked her interest in end-of-life issues, and helped form the Southwest Washington Life Transitions Coalition.
Her background made the decision to end curative care and begin hospice care an easy one.
“I told (my oncologist) when the treatment becomes worse than the disease, I wanna stop,” Marshall said. “I’d rather have two months feeling good than two and a half months and feeling bad the last month.”
Marshall isn’t the only one who prefers quality of life over quantity.
A recent poll commissioned by The Regence Foundation and National Journal found Pacific Northwest residents are more open to end-of-life options than the overall American public. According to the poll, 83 percent of Washingtonians believe enhancing the quality of life for seriously ill patients is more important than extending life for as long as possible. That compares to just 71 percent of Americans who share the same belief.
The poll also found most Washington residents don’t think health care providers talk openly enough with patients about palliative care options.
Palliative care uses a team approach to provide emotional, physical, spiritual and psychosocial care for patients and their families. People with serious illnesses can receive palliative care at any point of time, including in conjunction with curative care. Patients don’t have to be terminal to receive palliative care.
Hospice is essentially palliative care but only during the last six months of life. Hospice care is not provided in conjunction with curative interventions.
All too often, people wait until their final days or week of life to call hospice, Marshall said. That means patients and families are missing out on much of the support and comfort provided by hospice caregivers, she said.
“Hospice is a tool to help you when you’ve been diagnosed with a terminal illness,” Marshall said. “It’s not for the last 10 days of your life.”
Marshall and Dr. Tanya Stewart, medical director at Community Home Health & Hospice, agree providers are not always eager to discuss hospice with patients.
“Providers don’t want people to lose hope,” Stewart said.
Some providers and many patients consider hospice care as waving the white flag. But for Marshall, it was never about giving up.
She had reached the point where the treatment was worse than the illness, and she wanted to live the last days of her life, not spend them in a hospital bed.
In June, Marshall flew to Monterey, Calif., for her daughter’s wedding.
“It was the pinnacle of my life,” Marshall said. “Walking my daughter down the aisle meant a lot to me.”
In July, Marshall and her daughter, Tricia Pearlswig, went on an Alaskan cruise. And last month, Pearlswig quit her job and moved from her house in California to her mother’s home in Washougal.
Pearlswig said while some members of the family wanted Marshall to continue with treatment, she understood her mother’s decision.
“I really saw it from my mom’s perspective,” she said. “She didn’t want to pump her body with chemicals and be a robot. She wanted to be comfortable.”
The focus of Marshall’s care now is making sure she’s as comfortable as possible.
“Minnie is living the concept that hospice/palliative care is not about dying,” Stewart said, “it’s about living.”