A thick, stagnant cloud of cigarette smoke fills the space in front of 98-pound, 76-year-old Helena Caston. It sweeps across the dining room table and into the faces of Caston’s daughter and granddaughter. They sigh and, sliding their chairs backward, wave their hands in front of their faces. Caston is oblivious to their movements. She takes another puff of her cigarette and sorts through numerous medication bottles stacked up on a shelf on her dining room table. It’s 4 o’clock and time to take another pain pill. Caston was diagnosed with stage four lung cancer last year and has, at most, two weeks left to live.
“Dealing with cancer ain’t no fun,” Caston says. Nausea, decreased appetite, uncontrollable bodily functions, and a hacking cough are only some of the side effects of lung cancer. Sometimes they’re so severe and the pain so unbearable, even with a morphine pill, that Caston spends all day in bed, lying on her side watching TV Land, an oxygen tank buzzing in the background. Caston is so skinny and frail, she’s been compared to an anorexic.
Caston did go through several rounds of chemotherapy, but quit because it made her feel sick. “I had to decide between quality of life or quantity of life, and in the end… I think I chose quality.” During chemo, Caston lost all of her hair and she had to wear “caps,” which are basically beanies for cancer patients. “I didn’t like the way I looked and I still don’t, so I avoid mirrors.” These days, life is “difficult” for Caston.
Caston’s family has been taking time away from their own lives to see her every couple of months, but these last weeks have been the hardest. Caston is “actively dying,” and the family plans on staying with her until she passes.
As scared as Caston was when she was diagnosed, it has not made her quit smoking. “What would be the point in quitting now? I’m dying anyway and stopping now.. what good would it do?” she says. Caston began smoking in her early 20s but never quit because “it was hard.” She says she tried everything, but nothing worked. Although it’s not uncommon for a cancer patient to keep smoking, some would say it is unusual that a hospice aide buys the cigarettes for the patient. “I almost couldn’t believe it when I saw Angela [the hospice aide] return with a bag full of more cigarettes,” Eve, Caston’s oldest daughter, says. “She tells us that Angela ‘loves her so much,’” Eve says with a laugh.
A hospice aide buying cigarettes for a cancer patient is not typical, but it’s not “wrong,” says Kris Jewett, an RN and BSN in the hospice department at N.E. Washington Health Programs. “We’re not going to change the course of what’s going to happen by denying her cigarettes.” Jewett says hospice aides and caregivers can make suggestions, but ultimately it’s the patient who is in charge of their journey. “I would buy their cigarettes, yes. If a person has smoked their whole life and they get down to so few pleasures in life and smoking cigarettes is one of them, there’s no way I’m going to deny them that because the harm is done.”
Caston’s granddaughter, 22-year-old Caroline, says she had a defining moment when Caston asked her to get her another pack of cigarettes. “I didn’t think anything of it until she asked me to open it and hand her one. After she lit it up, I kind of just stood there. I felt like I had just handed her a death stick, like I had contributed somehow to her dying process.” Caroline says it was a “sobering moment” and wishes she hadn’t done it.
Last summer, when Caroline came to visit for a week, she had another similar moment. At the time, Caston still had energy to drive and walk around, so Caroline went grocery shopping with her. At the store, Caston filled the shopping cart with cakes, cookies, and ice cream, saying it was the only thing that would help her gain weight, which is what the doctor wanted. “I said to her, ‘Gramma, are you sure you should be eating this stuff?’ She asked what else should she be eating and I said, ‘Oh, I don’t know, fruits and veggies?’ But she just looked at me and said, ‘Honey, I’m dying.’ This is her answer to everything.”
Caston turned 76 years old in March, but she didn’t celebrate with cake; she has no appetite and only one tooth. Instead, she took calls from friends and family throughout the day who wanted to wish her a happy birthday. Having no appetite means all the food she bought when she did have an appetite sits in the refrigerator unless an aide can convince her it’s expired enough to toss. She is reluctant to throw anything out, insisting it can all be used for something. She is, as she calls herself, a farmer.
She owns three goats (at one point 12) and a handful of birds, including chickens, geese, and ducks, but now it’s a friend who cares for the animals. She lives far enough away from any proper town that there is no cell phone service. When she moved to Rabbit Hill, what she calls home, 30 years ago, she was excited and so “proud” that she could make the 30 acres what she wanted it to be. She rigged up a well for water, harvested the fixings for a healthy dinner from a garden of veggies and fruits, and last year she spent more than $1,000 to put in a composting toilet.
“She was such a lover of life, but I don’t really see that anymore,” Caroline says. “Sometimes I think she’s such a walking contradiction because she cares so much about the earth and healthy eating and wanting her family to eat healthy too, but she throws away her own money on cigarettes.”
Caston is frustrated as to how to spend her last days; she wants an exact death date so she can plan. “Lordy I hope it’s not soon. We’ve only just really started summer and oh glory it is so lovely! Oh, I do not wanna die and miss all this!”
Before her grandmother runs out of energy for the evening, Caroline kneels on the floor next to her, leaning over the computer, and shows her Google Earth. She “flies” them both to Egypt and hovers over the pyramids. “I want to go there,” Caston whispers as she clutches Caroline’s arm. “Let’s go, I’ll go with you!” Caroline says. But Caston just smiles; they both know she’ll never go.
Helena Caston passed away peacefully at her home Thursday, June 7.