“One should . . . be able to see things as hopeless and yet be determined to make them otherwise.”
– F. Scott Fitzgerald

I’m in a massive ballroom with numerous tables and promotional placards lining the walls and center. In attendance are every pharmaceutical manufacturer and their sales reps. All the biggies are here; Pfizer, Merck, Novartis, and AstraZeneca, to name a few. Their drugs are household names because they advertise them incessantly, and typically the actors look healthy and fit due to the benefits of their wonder drugs. In the real world, people who hope to live longer when diagnosed with stage four cancer can sometimes eke out a few extra months or so, if that.

Where is this place, and why am I here? I am attending a conference sponsored by The Arizona Clinical Oncology Society (TACOS.) Last summer, I was on a panel with some Arizona patient advocates to discuss disparities in cancer care among the local Indian populations. The discussion was interesting and put me on their radar. TACOS holds semiannual oncology conferences, and they invited me to attend this Spring Conference held at The Scottsdale Resort at McCormick Ranch in Scottsdale, AZ.

I am always interested in learning new things, and cancer research and cures are high on the list. I have a quick breakfast (much better choices than other conferences) and go to another large ballroom where about 150 people are listening to a speaker discuss cancer trends in the oncology world. It’s like being in a foreign country where someone speaks a different language. Occasionally, you hear a word or two you recognize, like remission or targeted therapy, but most of the rest is indecipherable. People around me chuckle, but I don’t get the inside jokes; it’s a lonely place for an outsider. I check the attendee list, and I am the ONLY ONE of about 200 people who does not represent a drug manufacturer or cancer hospital. I am definitely not one of the “in” crowd.

However, even though I am a stranger, this dedicated and intelligent group could not be more welcoming and curious. I roam around the display room, and the sales reps reach out and ask what big pharma or hospital I work with. When I tell them I am an end-of-life counselor, many look puzzled as to why I am here. I give them my brochure and say my role is to help their patients live their best life until they die, and though we see the promise of their work, their drugs often cannot cure or extend a life. It is me that patients turn to when they reach the end of their pharmaceutical road and mortality stares them in the face.

As I walk around and chat, people open up about a loved one and their struggles. One woman tells me about her grandmother with dementia.

“Can my Grandma stay in hospice? She seems like she’s improving, except for her dementia.”

I answer, “As long as a doctor certifies she is still declining, she can stay.”

A guy tells me his Dad had a series of strokes. I ask, “Does he have an advance directive or medical power-of-attorney?”

He replies, “No, it’s such a tough conversation, but I want to get it done.”

I hand him my tip sheet on creating an advance directive in five easy steps, offer to answer any questions his Dad might have, and wish him good luck. Another guy says sadly but proudly, “Mom had to go to a hospice facility to die because Dad could not care for her, but Dad died at home with my help.” These are deeply personal, moving, and for them, unexpected conversations. I am educating people who stare death in the face every day but have questions on how to face it in their own families.

This resort is one of my favorites; the grounds and décor are gorgeous – a Spanish-style hotel complete with Old World furnishings and cozy corners to soak up the ambiance. The delightful smell of some essential oils from a spa above wafts down. I wait in the buffet line, and again, great food, but I have no idea what people around me are talking about. I eat my sumptuous meal alone at a shady patio table in a quiet corner overlooking an outdoor fireplace with neon pink bougainvillea blooming everywhere. It is a glorious Arizona day, temps in the high 70s, bright blue sky, and severely sunny. It is a great day to be alive.

This cancer conference is not depressing; quite the contrary. It does my soul good to meet these wonderful folks helping humanity defeat the scourge of cancer, the number two killer in the USA. Later, I hear in a lecture that cancer deaths are down 37 percent. The speaker attributes this to lifestyle changes, fewer people smoking, and early detection and treatment. When I was in grammar school in the 1950s, a couple of classmates died from leukemia, back then a death sentence. While it is still the leading cause of cancer in children, remission rates and cures for leukemia are over 90 percent, statistics of which this group should be proud.

I have elicited a promise from my sister, a breast cancer pharmaceutical rep living in Texas, to join me at the TACOS November conference. This is her world, and I will gladly have someone translate the medical lingo and enjoy the lavish lunch.

As I write this blog, I hear news from an old friend of her husband’s passing of pancreatic cancer. “Since it had already metastasized, he/we opted for no oncology intervention … it would only prolong the inevitable. He said, I’ve been handed a death sentence, and I don’t want to be a guinea pig; he wanted, and I agreed to, home hospice care. On the 19th day after diagnosis, he peacefully passed.”

I hope when it is my time to go, I will face it with the same courage and grace as my friends’ and not chase illusionary treatments designed to extend my life without gaining any quality. Choosing the fork in the road as my friends did, I hope I experience a peaceful death at home, on my own terms, surrounded by my loved ones. How we die will be the last important decision we ever make.

Althea Halchuck is a patient advocate.