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A Tribute to James Michener

A Special Tribute to James Michener from the
Dialysis E-mail discussion group

Adaptation is an enormous power that successful dialysis patients seem to have an abundance of. In his many travels, Michener wrote about people adapting to life's challenges, and his ability to document these observations contributed to his success as a writer. What was so astounding was that once he required dialysis, he accepted the challenge of having to adapt his own life, and once again it contributed to his success, but this time as a patient. Michener was an amazing man, who while spending two years on hemodialysis - until the age of 90 - continued to be a prolific and active writer. He contributed My Dialysis Calendar to the Nephron Information Center, and it continues to serve as an inspiration to chronic dialysis patients, despite the irony of his later decision to withdraw from hemodialysis.

Michener withdrew from dialysis at the age of 90, after additional medical problems jeopardized the quality of his incredible life, and passed away October 16, 1997, in Austin, Texas, approximately one week later.

He remains a "source" of inspiration to patients as well as to members of the renal community. The life of James Michener is well documented on the Internet at the James A. Michener site. His legacy and spirit continue to thrive on bookshelves around the world.

What was most poignant were the comments made by other dialysis patients on Dialysis Patients On-line (an award-winning e-mail discussion group), that surrounded his decision to withdraw from dialysis. Thanks to Dale Ester, these comments have been reproduced here.


Date: Tue, 30 Sep 1997 20:37:01 -0500
From: Steve Fadem <fadem@bcm.tmc.edu>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: Michener's Calander

Thanks for posting this on the Dialysis site. Mr. Michener wrote this piece for The Nephron Information Center (http://nephron.com) at the urging of his local Austin nephrologist, Dr. Morgan, and his social worker. What amazes me is that he remains a brilliant and a clear thinker and writer even at his age. His letter was meant as a public service and inspiration to all patients (younger than he). We have ISDN in our dialysis facilities, we show his letter to those who wish to sign off dialysis early or miss treatments.

It is enshrined at http://nephron.com/michener.html"

Date: Tue, 30 Sep 1997 21:51:55 -0400 (EDT)
From: Beth VanSchaick <vanscb@Sage.EDU>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: Michener's Calander

Dr Fadem-
thank you for sharing this! I haven't gotten stupid, yet; but there are days when I just don't feel like hooking up (I'm a PD patient, on home choice cycler). Thanks for reminding me why I do! beth (also just starting out my life)
Date: Mon, 13 Oct 1997 10:39:06 -0500
From: David Reaves <dreaves@swbell.net>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: James Michener, was New Zealand Dialysis Controversy

F. Joseph Brown wrote:
> BTW, I just heard on the radio that author James Michener has withdrawn > from dialysis, stating that he 'no longer wanted to live like that.' >

I was saddened to hear of Mr. Michener's decision to stop dialysis. I've read so much of his work that it feels as if I know him well. His decision was the lead news story Sunday evening here (Austin, Texas).

As many have discussed recently the decision to continue life on dialysis, especially with other health problems, can be difficult. Though I didn't have the good fortune to know Mr. Ron Bull personally, his long term dialysis was an inspiration. With Mr. Michener the length of dialysis, was shorter, but his 90 years certainly should've helped provide the perspective necessary to make his decision.

The issue I'm facing is, that if these relative immortals can't face continued dialysis, how can I? I've faced the probability of dialysis for the past twenty years, since my mother died of heart-failure while traveling to hemo-dialysis. Given my current level of progression, I still have a few years before my kidneys fail, so I have probably 10 more years to dread dialysis before I even start!

Though I haven't started, I have given dialysis a great deal of thought. I have to believe that even though there may be hard days, that I will try to live as long as possible.

In my mind, I have a responsibility to my family and friends. My wife and two girls never knew my mother-- no chance to know what a positive person she was. For my daughters, they don't even know that they missed having a Grandma to love them that could teach them to sew, plant a garden, or read and discuss classic literature. I know that I'll do my best to live for my kids and their children. I want to know their kids someday-- teach them to build a birdhouse, take them fishing, go for walks in the woods. Perhaps something like that kept Mr. Bull going as long as he did.

I may reach a point someday, though, where I feel I can't continue. I hope that it will still be my decision to live, though I can never be sure. For now, I have to accept that God has a plan for my life. The limits of my kidney disease can be can be overcome with faith and, "Who knows?", the experiences may be necessary for me to accomplish something important.

As it says in the Christian New Testament, "For we know that all things work together for good, for those that love God and are called according to his purpose." (Romans 8:28)
David R.
Date: Mon, 13 Oct 1997 12:02:44 -0400 (EDT)
From: Beth VanSchaick <vanscb@Sage.EDU>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Cc: DIALYSIS List <dialysis@wugate.wustl.edu>
Subject: Re: New Zealand Dialysis Controversy

that Mr Michener has decided to give up the fight. Thi sis his choice, of course; but very sad to see it, when he wrote of the non-compliant man my age...
(let me see if I remember..)
Do not go gentle into that good night
Fight, fight against the dying rage....

(don't remember if it's Dylan or Donne)
(It's Dylan - ed)

Date: Mon, 13 Oct 1997 12:13:02 -0400 (EDT)
From: MicDLac@aol.com
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: James Michener, was New Zealand Dialysis Controversy

In a message dated 97-10-13 11:41:00 EDT, you write:

<< I have to accept that God has a plan for my life >>

My belief is that God gave me the right to choose and will support me whatever I choose even if it is not the right choice. (called mistakes, an exellent learning tool)

Date: Mon, 13 Oct 1997 11:03:38 -0700
From: LadyRain <ladyrain@gte.net>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: Goodbye Yellow Brick Road

Because dialysis is considered an extraordinary measure of keeping us alive. Discontinuing treatment is just letting nature take it's course.
Deb :o)
Date: Tue, 14 Oct 1997 13:10:38 -0400 (EDT)
From: George Harper <harperg@mail.floyd.public.lib.ga.us>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: RE: Yellow brick road

I believe the debate whether or not withdrawal from dialysis is suicide is
a rhetorical fiction. I think the real question is whether or not you feel it is morally wrong to willfully take your own life. If you do think it is morally wrong, then I don't think it matters whether you put a bullet in your head while you are healthy, or whether you pull the plug on dialysis treatments which are maintaining your life. The point is you are willfully killing yourself. Arguments that taking oneself off dialysis is not suicide because you are only allowing nature to take its course are not impressive. That's like arguing that if a parachutist removes his parachute on the descent, it is not suicide because he is only allowing nature to take its course after removing the artificial support system.

I believe we all have that choice, and as a 17 year home hemodialysis patient I can see how patients like myself might get into a medical situation that is intolerable.

I have noticed that there are a lot of articles in the nephrology literature lately which discuss withdrawal from dialysis. It seems that many nephrology professionals are beginning to view withdrawal as a viable option for some patients. The thing that bothers me is that they all put the burden on the patient. Many of them describe death by uremia as a "good death." I think this is a bunch of bull. I've always read that death by uremic poisoning is one of the worst deaths that one could have, and the times I've stretched the interval a little I felt horrible. I don't think I would ever allow myself to die of uremia. I would take action while I was still in good shape.

An ESRD patient who has made an informed decision to end life should not be expected to check into a hospital and slowly die of uremia even though the process may be ameliorated by narcotics. Nephrology professionals should face up to their obligation to their patients who need physician assisted suicide. Dr. Kevorkian has certainly advanced the debate, and I imagine it won't be long until physician assisted suicide will be an accepted practice in the U.S.

George E. Harper
11 London Lane SE
Rome, Georgia 30161-9467
E-mail: harperg@mail.floyd.public.lib.ga.us
Ph: 706-232-0793
Mobile: 706-506-1108
Date: Tue, 14 Oct 1997 22:17:06 -0700
From: Robert Schuh <rschuh@ix.netcom.com>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: pulling the plug

Lee wrote:
> Robert,
> Haven't you ever heard of ultrafiltration?

I have lee, but how is this possible without using a dialyzer and also pulling out the toxins? Even if it is possible, I think the entire premise is ridiculous. If you are going to KILL YOURSELF, yes, this is what you are doing if you stop dialysis, don't jerk around with stopping dialysis, get a gun, take some pills, jump off of a tall building etc. Get it over with. All you are doing with this cowardly refusal of dialysis bullshit is putting your loved ones through prolonged grief. People who take their own lives end up hurting their family and friends even more by their own self centerness. Dialysis is not a death penalty, but a savior of life.

Robert Schuh


Date: Wed, 15 Oct 1997 12:05:04 -0500
From: JK Warren <kwarren@gte.net>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: pulling the plug

The recent decision by James Michener and the death of Ron Bull has brought this subject to the attention of many people.. Regardless of how any of us feel it is still ultimately the patients decision.. They are free to discontinue treatment just as they are free to stop eating..

Too many times have I seen patients at my clinic either unable to express themselves about their wishes or begging anyone who will listen to "just let me die" but their desires are over-ridden by family or doctors..

I have seen some of these people die and also have experienced the after-effects of a violent suicide when my brother shot himself to death.. I still have visions of my arms covered in his blood when I cleaned up the mess.. The damage to family and freinds in such cases is indescribable.. But simply allowing nature to take its course when you stop dialysis allows some of the horror to be deflected.. After all, you don't have the option of NOT dying.. It will happen sooner or later..

There are some here that consider hemo an almost barbaric treatment in its effects on the body.. In some cases, it may be.. But it is also the only modality for some of us and to deny any option to those restricted in such a way, to me, is cruel and possibly sadistic

Date: Wed, 15 Oct 1997 15:27:59 -0400
From: Mary Demick <mddemick@erols.com>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: pulling the plug

JK Warren wrote:
> Regardless of how any of us feel it is still ultimately the patients > decision. > But it is also the only modality for some of us and to deny any option to > those restricted in such a way, to me, is cruel and possibly sadistic.

I agree with your entire message, especially the quotes above. You expressed what I feel so eloquently. I have been grappling with a response for days, now, and just couldn't come up with the words. Thanks.

Finally, I too, have been close to someone who opted to refuse dialysis and also to someone who had a close friend "swallow a shotgun," to paraphrase Robert. the difference in the impact on these two families is immense. The family who helped their wife and mother during the period of treatment refusal and ultimate death are at peace with themselves for giving her the opportunity to "go easy." She discussed her decision at great length with her family members and was able to control, as much as possible, how she would die. On the other hand, I believe she would have attempted to "stick it out," at great emotional and mental cost to herself, if one of her family members had adamantly opposed her choice.

In the second case, my friend found her neighbor and close friend in his apartment surrounded by blood and brain matter. She will never forget this mental picture and often, it overshadows memories of joy she had of this friend. While suicide due to depression may be a very different thing from choosing not to accept treatment, the result is the same and the ones remaining behind are those that suffer. And Robert is right, no matter how you choose to die, the result is, once again, the same. It only differs for those who loved and cared for you. How do you want your family to remember you and your death?

Mary D.


Date: Thu, 16 Oct 1997 12:04:42 -0700
From: Andrew Lundin <plundin@pol.net>
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: food, fluid and dying

Here's a question and some comments to raise a dicussion.

When a patient with a terminal illness is dying or a dialysis patient (patient with a terminal illness put off indefinitely by dialysis) decides to stop dialysis, what should about food and fluid?

Many feel that in the dying patient food and fluid should not be withheld and should be given to the patient by tube or IV if necessary - so-called minimal care. In the dialysis patients paradoxically, food high in potassium would bring death sooner and without discomfort. Fluid on the other hand, if too much, could lead to suffocation.

For millenia the "natural way of death" for those too old or unable to care for themselves (apart from being trampled by a mammoth, eaten by a lion, dying in childbirth, etc) has been to die of dehydration after being abandoned by the tribe. Only in the last 100 years or so have we been able to give liquid to patients by tube.

It has been discovered that dehydration induces release of endorphins (morphine like agents made in the body that relax) and hydration suppresses their release. While terminally ill patients in the final stages of dying should be free to ask for food or fluid as desired, most don't and will die more peacefully if it is not forced.

For dialysis patients who want to stop treatments it makes sense to me.

Peter Lundin


Date: Sat, 18 Oct 1997 16:04:52 -0400 (EDT)

From: NOONIEGIRL@aol.com
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: Goodbye MR.Michener WAS:This Moment

I am moved to tears to hear of Mr. Michener's passing. When he stopped his treatments we all knew it wouldn't be long before he passed. I hope his passing was quiet and not too painful.

Here is a quote I found when thumbing thru the Reader's Digest. When I saw who said it I decided to share it with all of you.

"We are never prepared for what we expect."

---James A.Michener,

Caravans (Random house)

Farewell Mr. Michener you will be sorely missed. :~(
Date: Sat, 18 Oct 1997 19:25:10 -0700 (MST)
From: Dale Ester <dalee@evergreen.com>
Reply-To: dialysis@wugate.wustl.edu
To: Dialysis Friends <dialysis@wugate.wustl.edu>
Subject: James Michener (was Re: This Moment)

On Sat, 18 Oct 1997 Carol2613@aol.com wrote:

> Can anyone tell me how long James Mitchner was on dialysis?

About two years. As a note, Michener had a comorbid heart problem (in conjunction prior to ESRD, not because of it). Dialysis may have been accentuating the heart condition ... which could have led to eventual cardiac arrest. Which would have been worse?

We simply don't know the specific details to his decision ... let us remember him for his ability to make a good conscious go of utilizing dialysis and his advise directed towards "his ESRD friends" to do the same, not for his cognitive choice to discontinue treatment as we do not know the specifics to his physical body and the struggling of Life within it which lead to his ultimate finality.

As was his books, the endings were always a glorious surprise. Why should we have expected anything less suggesting tribute to his mental abilities to continue to "make us wonder" even in his passing?

Dale Ester


date: Mon, 20 Oct 1997 00:36:02 -0400 (EDT)

From: NOONIEGIRL@aol.com
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: Goodbye MR.Michener WAS:This Moment

Ronni and all,

This is a small bit of his online obituary------

""He died at his Austin, TX, home surrounded by a few close friends ten days after he chose to stop dialysis treatment. He had recently suffered several medical setbacks.""



The reason the news makes 4 hrs 3x a week sound unusual is because they know little or nothing about dialysis and to them that amount of time sounds like its a huge amount. Now when I tell people who aren't familiar with Dialysis how long I am on the machine. their reaction is one of surprise that I have to be hooked uo "so long."

take care {{{{HUGS}}}}}



Date: Mon, 20 Oct 1997 11:07:42 -0400 (EDT)
From: ROBINKRIS@aol.com
Reply-To: dialysis@wugate.wustl.edu
To: dialysis@wugate.wustl.edu
Subject: Re: James Michener (was Re: This Moment)

To follow up with Dale's message regarding Mr. Michener. I had the priviledge of interviewing him for RENALIFE eight months after he began dialysis. He was an inspiration and a very kind, thoughtful man. He told me he gained a great deal from his fellow patients in the unit. They gave him inspiration. He told me at that time that a woman who had been on dialysis for 15 years encouraged him and taught him to not be fearful. Dale is correct--he had many other health issues besides ESRD that probably led to his decision. After meeting him, I firmly believe he made the decision to end dialysis after much analyzation and consideration.


-------end of Michener Compilation--------------------

Dale Ester

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