Roz Reads: The Cost Of Hope

I knew Terence Foley as the genial man who would pick up his son at afternoon’s end when our kids were teenagers. We’d chat while waiting for them to finish up. Foley was witty and well-informed on a wide range of topics and I enjoyed our conversations. 

But it was his wife Amanda who was the family’s star. At a social gathering, when asked about her job, Amada would say,  “I work at the Philadelphia Inquirer.” She didn’t merely work there, she ran the entire paper!  She had also, by the way, won a Pulitzer. I admired both her accomplishments and her modesty about them. 

I was shocked and saddened when I heard Foley had died. I hadn’t realized he was ill. Then, recently, absorbed in a “Newsweek” excerpt of the book,  “The Cost Of Hope,“ I suddenly realized I was reading about Foley! Amanda had written this memoir about their life together and his illness,  with a critical look at his end-of-life treatment.     

When I read the book, I learned what the engaging man I’d so enjoyed chatting with had actually been going through.  Foley was diagnosed with kidney cancer in 2000, and fought the cancer until he died, seven years later. Two years after her husband’s death,  Bennett decided to revisit and examine this experience. She interviewed his doctors, examined his tests, questioned his diagnosis,  and looked at every recommendation, every medication and every treatment, with an eye to not only understanding her husband’s experience but what it means, given our health care system, for all of us.

The result is both riveting and unsettling.    

When Amanda met Terence, in China in the 80s, he was a deeply unconventional man who spoke six languages, played fourteen instruments and pursued a variety of passions. It wasn’t love at first sight. To some readers, it won’t seem like love at all. There were tender moments and grand romantic gestures, but there was also plenty of sniping, bickering and shouting. Concluded Bennett, at the time:  “I am unhappy when he is around. I am miserable when he is gone.“  

This to many, wouldn’t signal “I need this man,” but “I need therapy.” Which isn’t to say that Bennett’s love for Foley made no sense. He was just as smart as she was, he believed in her completely and his obvious need for her was compelling. As was his eagerness to help her shine.  “You are going to be somebody,“ he told her. “You’re going to need somebody to take care of you.” They married, had a son and adopted a daughter.      

Foley turned out to be just the right husband for Bennett, as well as a loving and devoted father.  She describes a business trip to San Francisco, where she spent the day in a conference while Foley and one-year-old Terry had a blast riding cable cars. If you’re a mom with an ultra-challenging career, you’re going to need a husband like Terence Foley.   

After Foley was diagnosed, the family kept his illness under wraps. But behind the everything-is-okay façade,  his life became a grueling series of doctor visits, diagnostic tests and cutting edge treatments. As Bennett describes it, contemporary medicine is a profoundly confusing labyrinth, which the patient must navigate with little guidance. As Foley sought treatment from one specialist after another,  nobody but Bennett was paying attention to the whole picture, and, lacking medical training,  she couldn’t evaluate what she saw. The doctors they counted on to save Foley not only failed to agree on crucial aspects of his diagnosis and treatment, but often contradicted each other. Nor were they inclined to work together. Foley and Bennett had no way to evaluate or reconcile their divergent opinions and recommendations.   

Foley’s treatment cost a small fortune but insurance covered it, so the money was spent without a second thought. The problem, Bennett concludes, is not that the specialists, diagnostic procedures and treatments were expensive but that so many of them, in retrospect, seem unnecessary. Further, beyond a certain point, the treatment Foley received was utterly useless, painfully drawing out his death rather than preserving his life.  

Foley, with the help of his wife and a number of well-intentioned doctors,  continued to fight his cancer long past the point where the fight could possibly do any good.  Dying, he was unable to let hope go and prepare for the end.    
“The Cost of Hope” takes a hard look at a tough topic. Nobody wants to die. But since we must, we want to die well. Did Terence Foley die well?  Modern medicine kept him alive for many precious years. But modern medicine, combined with his own powers of denial, ultimately failed him. He could have been, but was not, at peace when he died.   

What  does it mean to die well? Can the way we practice medicine be improved so that more of us are spared the worst parts of what Terence Foley went through?  “ The Cost Of Hope” asks, but cannot answer, this question.  

(This review first appeared on www.womensvoicesforchange.org.)