Dying well: If Symptoms Persist

“Dying is an art, like everything else. I do it exceptionally well.” — Sylvia Plath, American Poet (1932-62) Lady Lazarus

How do you tell a friend or a loved one that she is dying? Do you tell her that she is? In this time of “transparency” and of “full disclosure,” people are tempted to do the same to dying patients. In a 1961 survey of British doctors, 90 percent thought that patients ought not to be told that they were terminal. By 1979, only three percent thought this was right. One wonders what medical professionals and the public think about telling the truth to dying patients, in 2009. End-of-life issues continue to confuse even doctors because the subject of death is taboo. After all, death like life only comes once and very few want it to discuss openly, except perhaps insurance agents and undertakers. It is possible to prepare for a loved one’s death in a way that is responsible and caring. It should not mean that you want her to die sooner. There are four questions that guide a doctor or a designated relative or friend to what “level of truth” the patient can be most comfortable with. Some cancer patients don’t want to know that they are dying – truly, ignorance can be bliss. That is why it is wise to first ask, “How much have you been told?” The second question is “Are you the sort of person who wants to know exactly what’s going on?” The third is “Would you like me to tell you the full details of your diagnosis?” And finally, “Do you want me to go on?” Doctors and nurses are notorious for cloaking bad news in medical jargon. The simplest explanation is usually the best. Once the bad news has been broken, a patient may want a second opinion. It is her absolute right to get one. Roger Bone, a doctor who was dying of cancer, wrote, “A second opinion will relieve your mind and resolve doubts one way or another that a major mistake has not been made.”

Dying people have voiced out that the most distressing and painful experiences involve silence and avoidance about their final weeks or days. Especially for those wanting to make peace with themselves. These questions are most helpful:

1. What have you enjoyed most in this life? Ask them snapshot memories that have made it all worthwhile. Surely this is the time to reminisce.
2. What would you like someone to hear that you have never said? Perhaps he has never said “I love you,” to a son or daughter. Maybe it’s not too late. Maybe he would like to forgive someone or ask forgiveness, too.
3. What are you most frightened of? This is the time to assure the patient of pain control and the avoidance of suffering even in his last moments.
4. What do you need to do? It is very difficult to do things from a hospital bed. In practical terms, this could mean anything from writing a will, seeing the priest or minister to feeding the aquarium fish at home. Reasonable requests should be written down and carried out.

When do we know that the patient is ready for death? This is probably not a precise moment but a slow surrender to the inevitable. One clue is how the dying person begins to direct her attention to loved ones. Sometimes the hardest part about dying is the effect it has on your family and friends. Helping them deal with your death helps you find peace and comfort. Now whether death is transition or extinction is a matter of philosophy, or religion. What we do know is that we can help the dying patient to truly rest in peace.

The Role of Forests

Forests provide habitat for a wide variety of plants and animals and perform many other important functions that affect humans. Photosynthesis is the chemical process in the leaves that uses sunlight and carbon dioxide to produce energy-supplying sugars for the tree or plant—in the process the foliage of the plants and trees gives off pure oxygen for breathing. Forests also prevent erosion, the wearing away of soil by wind and rain. In bare landscapes with little or no vegetation, heavy rains fall uniformly over large areas and can wash soil into rivers and streams and cause landslides and flooding. This leads to ecosystems that are deprived of both water and soil, which are quickly carried away in rivers and streams. In forested areas the forest canopy (treetops) intercepts and gradually re-distributes precipitation that would otherwise cause this flooding and erosion—some of the precipitation flows down the bark of the trunks as stemflow, the rest percolates through the branches and foliage as throughfall. This slower and nonuniform distribution of the rain ensures that soil and water will not be immediately carried away. In addition, the roots of the trees and other vegetation hold the soil in place and prevent flooding and clouding of streams and rivers. Forests also increase the ability of the land to capture and store valuable water. The canopy is especially efficient at capturing water from fog—condensed, cloudlike water vapor—which it distributes, like precipitation, into the vegetation and soil. Water stored in tree roots, trunks, stems, and foliage, as well as the soil of the forest floor, enables forests to maintain an even flow of water in rivers and streams in times of heavy precipitation or drought.

Environmental Protection and Flood Management

The disastrous inundation of a large part of Metro Manila by the recent typhoons has left behind vivid images of destruction of lives and property. It should serve as a grim reminder of an urgent need for a comprehensive system to cope with any future weather-related calamity. That we are visited by so many typhoons in a year is a fact of our national life. But the resulting damage can be mitigated with carefully studied and well- implemented human interventions. Such immediate knee-jerk reactions as dredging of rivers and creeks and the de-clogging of the drainage system are understandable and predictable. But what good is a dredging program if non-biodegradable waste materials are thrown into the waterways repeatedly? And what good is de-clogging of drainage arteries if the Solid Waste Management Act is not strictly implemented at the barangay level? These are nothing but short-lived solutions! Informal settlers living along river banks and esteros, who contribute to the clogging problem, have time and again been the target beneficiaries of the perennial relocation proposal. Identifying a relocation site is not enough. Here is where government and the private sector should work hand in hand to address this social concern. To be viable, the relocation site should have easy access to water and electricity. There should also be school facilities, medical clinics and livelihood opportunities. The beneficiaries as stakeholders should contribute time and labor in site beautification. They too must realize that they have something to share. Relocation work should be supplemented by a sustained community development program. Such a program should include values formation, leadership training for community leaders and imparting micro-entrepreneurial skills. There are NGO’s in a position to help. Since Laguna Bay and the Pasig River and its tributaries are the major components of a flood mitigation program, their continuous dredging is necessary. To reduce the level of siltation in the lake due to soil erosion, any ongoing tree planting program should be expanded not only on the mountain range that sends excess water to the lake, but also all other mountain ranges of Luzon, Visayas and Mindanao. The whole idea is the re-greening of our mountains in order to increase significantly their rain absorptive capacity. The net effect is an improvement on the subterranean water level and the prevention of huge volume of water rushing from the mountains. Indeed, there is a direct correlation between environmental protection and flood management. When we take good care of our environment, we are able to minimize the impact of floods.

Nuclear Weapons Should Be Abolished?

With the invention of nuclear arms, we human beings brought ourselves face-to-face with the prospect of extinguishing the human race by our own hand. A decision to abolish nuclear weapons would represent a decision to survive. This quest for survival is the deepest, most important, and most enduring of the imperatives for nuclear abolition. Inseparable from it is the imperative of sparing the Earth’s ecosphere from irreparable damage. Nuclear war also threatens catastrophes that, although less encompassing than extinction, are still outside all historical comparison. On August 6, 1945, moments after the United States dropped an atomic bomb on Hiroshima, Japan, a history professor living in the hills of the city turned around, and, in his words, “saw that Hiroshima had disappeared.” In a flash, the city and most of its people had been annihilated. Those who did not die immediately were exposed to unimaginable suffering. A grocer in the city later said of the long lines of the injured filing out of the city that “you couldn’t tell whether you were looking at them from in front or in back.” The invention of the hydrogen bomb multiplied the explosive power of the atomic bomb by a thousand fold. Any city on earth can be razed to its foundations by a thermonuclear bomb of the appropriate size. Ten bombs can annihilate ten cities; a hundred bombs a hundred cities. A single Trident submarine can carry enough nuclear bombs to level an entire continent. Even more widely destructive than the explosive power of the weapons is their radioactive fallout, which causes radiation sickness. A hydrogen bomb with the explosive power of 1,000 tons of TNT will, given average weather conditions, send a plume of radiation downwind over an area of some 2,080 sq km (800 sq mi). Ten bombs can lethally irradiate 20,800 sq km (8,000 sq mi); a hundred bombs, 200,800 sq km (800,000 sq mi); and so on. There is, simply, no meaningful limit on the destructive power of nuclear bombs. They put at mortal risk all that we human beings are, all that we have ever been, and all that we ever will be. Antiabolitionists argue that abolishing nuclear weapons is reckless because inspection can never be adequate. Even if the hardware is eliminated, they correctly point out, nuclear know-how will remain, enabling irresponsible nations—“rogue states”—to violate an abolition agreement and build nuclear arms, whether secretly or openly. In a world in which all nations have disarmed, they conclude, any nation that comes to possess even a few nuclear weapons will rule. Removal of nuclear danger, they further maintain, will permit conventional war to break out. According to this view, nuclear weapons are a benefit because, through the discipline of the balance of terror, they prevent conventional war—admittedly, no small gain.

It would be wrong to suggest that a world without nuclear arms would be without danger, even nuclear danger. The risk of cheating would be real, as would the risk that a possible conventional war might spin out of control and spur nuclear rearmament. The point, however, is that those perils are lower by several orders of magnitude than the ones in the world of nuclear anarchy toward which our inaction points us now. We are not called to choose between danger and perfect safety but between two species of danger. Reflection shows that the level of risk under an abolition agreement is far lower than that which exists in a world without one. There are further reasons to abolish nuclear weapons. Since the destruction of Nagasaki, no nuclear weapon has been used in war. In a world of proliferating arsenals no one knows how long this good luck will hold. What we can and do know is that over the long run no civilization can be based on a willingness to kill hundreds of millions of innocent people. The nuclear powers are left with their own insistence, unrelated to any particular peril, on preserving these means of annihilation. The exploded bomb can end human life on Earth. The unexploded bomb—the incarnation of the worst impulses of human beings—spreads moral devastation within. We are brought face to face with ourselves—with the character and proclivities of the liberal civilization that now bids to dominate the world’s affairs. Can we preserve this civilization without menacing it and all life on earth with annihilation? Or has our idea of civilization come, by some twisted logic, to incorporate the threat of annihilation into its essence? Surely an acceptance of annihilation contradicts the avowed principles of our civilization at every point and, even in the continued absence of nuclear war, darkens its future. Freeing the world from this burden is yet another reason to abolish nuclear arms.