Toward a better quality of life

Four years ago I was recovering from a mastectomy. It was my second bout with breast cancer in 16 years. Even though my doctor said it was unrelated, I had misgivings. During this time when I was concerned about which direction my life would go, Mary Ann moved into a rehab room a few doors from me.

When I dropped in for a visit, Mary Ann was pleasant and quite outgoing. She was about my age but looked older and quite tired. Mary Ann was divorced and had a grown son, and it was clear that while she doted on him she also depended on him. During our chat I learned that a few years earlier she found a lump in her breast and did nothing about it.

Instead, she continued working as a customer service representative for a major grocery store chain. She loved that job and the people she met. She worked until the advancing cancer weakened her and she could no longer stand.

Then, she spent weeks in the hospital while rods were surgically inserted to stabilize her spine and ribs and allow her some function. Though she was paraplegic (from the Stage IV breast cancer), she could propel a manual wheelchair and had no pain.

Because she felt getting up with a lift was too big a deal, Mary Ann spent most of her time in bed. But she kept quite busy talking on the phone, chatting with her many visitors, reading, and watching TV.

After she had been in the facility for about three months, she became depressed about her mounting medical bills. Her insurance was not paying. She needed good care but wanted to go home. Many staff came to cheer her and give her clinical and personal options. Unfortunately, she was not pleased with much they had to say.

Because of this a nurse asked me if I would talk to her. She said Mary Ann had a sore on her bottom that could not remain clean because of her incontinence. She said Mary Ann needed a colostomy to allow the sore to dry and possibly heal.

I said I did not feel comfortable advocating a colostomy, since I had refused one for severe constipation myself. The nurse suggested I tell Mary Ann that a colostomy could improve her quality of life. I told the nurse I had to think about it.

Mary Ann was going through so much. How could she ignore a breast lump? She was devoted to her Christian faith—did she think praying would make it go away? I told myself that she had reasons for doing what she did.

Despite her worries about bills, Mary Ann remained upbeat. She talked about the power chair she was receiving and finding a van to transport it. She also made plans to go home.

I decided to search the Internet for positive reasons to have a colostomy. I found several articles written by paraplegics and quadriplegics who had colostomies to prevent “involuntary bowel movements.” They wrote that the colostomy allowed them to go places without worrying about accidents. I thought Mary Ann should have the opportunity to read these articles. I also got her information about the colostomy procedure and the assistance available afterwards.

When I gave the information to Mary Ann, I said I was not telling her what to do. I said the articles were about paraplegics and their positive feelings after having a colostomy. I also gave her the aftercare resources.

Mary Ann read the materials, but she decided to forgo the colostomy. Instead, she moved back home with home health aides to do her care. I was concerned she would not get up at home as she had at the facility. But I knew she wanted to be in familiar surroundings.

When I called Mary Ann later that year at Christmas, she said she was doing well. She told me she spent most of her time in bed. She also had the colostomy performed and was pleased to no longer have to deal with bedsore problems. Her quality of life had been improved.

A year later, a friend told me Mary Ann passed away in her home.

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