Monday, December 26, 2016

The Widowhood Effect

I sit cross-legged on a white mat spread on the bathroom floor and examine the rows of medication lined up on the shelf of the vanity – neat piles of green-and-white boxes of blood thinners, a rainbow of pill bottles, painkillers worth thousands of dollars. I study the labels: Percocet, Zofran, Maxeran, dexamethasone. Take daily. Take twice daily. Take with food. Do not crush. Do not chew. Take as needed.

I wonder if a one-month supply of drugs intended to save a sick person’s life is enough to end a healthy one’s. It probably is if you consume them not as directed. Chew them, crush them, don’t take with food. Take handfuls at the same time. But the order matters. You must swallow an anti-nausea pill first so you don’t vomit up a $248 cancer pill. This, I know. I’ve watched someone take cancer medication when he was trying not to die.

I remember the day we brought these drugs home. On the afternoon of June 1, 2013, my 36-year-old husband, Spencer McLean, was discharged from Calgary’s Tom Baker Cancer Centre. As he changed from his hospital gown to his jeans, he let out a sob; he’d grown so thin that his jeans kept sliding down even with his belt cinched as tight as it could go.

On our way out of the cancer centre, we stopped at the hospital pharmacy to fill his prescriptions. We picked up a one-month’s supply that cost twice our monthly mortgage payment, despite our private insurance and government coverage of his $7,000-a-month cancer therapy. We sat as we waited nearly an hour for the medications to be prepared; Spencer was too tired to stand. When the pharmacist called us to the front, he handed us three white plastic bags filled with boxes and bottles.

We stepped into the foyer of our condo nervously. Our parents had come by to clean up the packaging and plastic needle covers the paramedics had tossed to the floor of our living room in a rush one week earlier before they whisked Spencer to emergency. Neither of us was comfortable being home. We knew a fair amount about medicine and cancer – he, a surgeon; me, a medical journalist. We knew Spencer’s cancer was extraordinarily aggressive. In the three weeks after his diagnosis, cancer galloped through his body at a ruthless pace, laying claim to his kidneys, his lungs, his liver. In its wake, clots formed in his blood, threatening to block arteries and veins. One had already clogged the vessel carrying blood to his liver, causing the organ to swell so large it extended across his abdomen and hogged any space that rightfully belonged to food. Each day became a balancing act in blood consistency: too thin, his kidney bled profusely; too thick, clots threatened to meander into his lungs and kill him.

At home that evening, right on schedule at 7 o’clock, Spencer took his cancer medication, then vomited it up. By morning, he was peeing out blood clots and couldn’t eat or drink. We reached our oncologist on his cellphone and he agreed we needed to return to hospital. We’d been home less than 24 hours.

Spencer and I lay down on our queen-size bed, on top of the white-and-beige duvet we’d received as a wedding present. On the other side of our open window, a bird tapped its beak on a metal vent. Spencer lay on his left side; his right ached too much to place pressure on it. I nuzzled in behind him and put my nose to his back, where I imagined his diseased kidney to be. We wept like that for half an hour. I inhaled deeply and pretended that I was drawing cancer out of his body and into mine. Then, Spencer said, “Let’s go.”

That was the last time we were home together. Three and a half weeks later, Spencer died of complications from renal-cell carcinoma – an agonizing 42 days after the day we sat holding hands and stunned on a hospital bed, as a nephrologist told us the diagnosis.

The widowhood effect

Now, our home is my home. Spencer left everything to me; he’d no time to be more deliberate in his will. He gave me his beloved bikes and skis, his damn pager that woke us up in the middle of the night, his collection of model leg bones and pelvises, and a bathroom full of drugs that were supposed to save his life.

The pile of medication in our bathroom – my bathroom, now – is a remnant of a life that no longer exists. I don’t know whether to dispose of these drugs or keep them in case I need them to end my own life. At 36, I am a widow.

The widowed are two and a half times more likely to die by suicide in the first year of widowhood than the general population. We are, in fact, more likely to die of many causes: heart attacks, car accidents, cancer, many seemingly random afflictions that are not so random after all. There’s a name for this in the scientific literature: the widowhood effect.

It’s dated now but a 1986 paper in the British Medical Journal explored death after bereavement. It opens atypically for a scientific paper: “The broken heart is well established in poetry and prose, but is there any scientific basis for such romantic imagery?” Indeed, there is, according to the author. He found that a strong association exists between spousal bereavement and death.

Multiple studies in the last 40 years have confirmed these findings. A meta-analysis published in 2012 that looked at all published studies of the widowhood effect found widowhood is associated with 22-per-cent higher risk of death compared to the married population. The effect is most pronounced among younger widows and widowers, defined as those in their 40s and 50s. The widowed in their 30s, like me, also die at higher rates than our married counterparts but the difference is not statistically significant – not because it is insignificant but because there are too few in this age group to detect measurable differences.

We are too few and too young to be significant.

by Christina Frangou, Globe and Mail | Read more:
Image: Drew Shannon