Cost of Dying: One nurse’s end-of-life choice was surprisingly simple — and liberating

by Lisa M. Krieger

In her last two months, Gayla Caliva stargazed and savored Jamaican food. She enjoyed picnics and her book club, trips to the zoo, the aquarium and the beach.

Her bucket list overflowed with forbidden foods. “And why shouldn’t it?” she reasoned.

She canceled her mammogram. “Teeth cleaning? Let it go!” she said.

How will you respond, when death calls your name?

Caliva chose comfort care over combat, rejecting life-prolonging dialysis for a life-affirming ending.

As a retired nurse, the free-spirited San Jose woman had seen plenty of bad deaths, and knew her failing kidneys would assure a more gentle demise, providing her the gift of time to say goodbye. How much time? Nobody could say.

But at 70, with no prospect of a cure, and influenced by her mother’s six-year dependence on dialysis, she foresaw only exhaustion when doctors gave her a choice in July.

“I didn’t have to think about it, because I already knew,” she said. “I didn’t want dialysis. Now I think, well now, I’ve signed my death sentence or something. I thought it would be scary. I can’t believe how unperturbed I was, how easy that came.”

She vowed to enjoy the dwindling days, savoring moments with her best friend and fellow nurse, Ann Raynor, and daughter, Diane Caliva.

The clarity of her decision also gave her loved ones the ability to celebrate her final days, more than suffer her death.

“It made you almost shift into those same gears,” Diane Caliva said. “It was like, OK, I’m just going to go with her on this, because she’s embraced it.”

Her mother’s one call for help was to Pathways Hospice, based in Sunnyvale. Like Caliva, 1.1 million Americans a year choose hospice care, in which nurses monitor patients and provide pain medication to ease them through life’s final journey, often at home.

Others come to a different conclusion, seeking treatments to prolong life that can buy precious time: a family graduation or wedding, perhaps.

The hard part is getting the information to make the right choice. A recent national study, published in the Oct. 25 New England Journal of Medicine, found that patients often fail to understand the limitations of treatment. Chasing miracles can delay the transition to comfort care, the journal concluded.

Gayla’s end in September was not, as she once dreamed, a romantic scene of winter sun streaming through the window, listening to the love duet from Puccini’s “Madame Butterfly.”

She slept a lot. She had trouble breathing, and there was confusion, with some agitation and pain. But her discomfort was brief and controlled. She was home, not hospitalized.

She died, like she lived, on her own terms.

“Live like a washrag? Weak as a kitten? All your food tastes like crap? That’s not a quality life,” she said. “I didn’t want that. Nope, not for me.”

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