Our mother was one of those smooth, manipulative old ladies who listen attentively and admiringly to any stranger, making him or her feel very important. Because of this her doctors loved her. They were quite proud of having successfully treated her cardiac irregularities, her moderately severe inflammatory arthritis, and her Meniere syndrome. But because they had failed completely in curing her constipation, she did not respect them.

Nevertheless, because mother was so unfailingly courteous—even to those whom she did not respect—her doctors continued to think very highly of her. Despite the many ailments of her advanced age, she was "a remarkable old lady," "a delightful patient," "mentally clear as a bell," and "frail, but in full enjoyment of her faculties." So when she refused surgery for her rapidly growing rectal villous adenoma, they found it a little hard to understand.

The polyp had been found during still another long workup for constipation, her constant and recurrent complaint. It obviously required surgical excision. The surgeon, Dr. McPherson, had high hopes of being able to do a segmental resection and restore bowel continuity, but he could not guarantee she would not need a colostomy. And right there he lost our mother.

Now you need to know, as the surgeon did not, the reason for mother's adamant refusal to submit to curative surgery for a lesion that would unquestionably kill her if it were not removed. It was the senior center. Mother's only social life was the noon congregate meal she ate there daily. And daily she listened with great interest and bated breath to every life story offered by the other old people.

It was part of our mother's personality to believe in every one of those lives, regardless of how it had been either gilded into a triumph of wartime heroism and business success, or fashioned into a true horror of endless bad luck, persecution, and chronic illness. She enjoyed the horror stories most.

It seemed that almost every old woman at the center had undutiful children who had stolen her pitiful property through one subterfuge or another and then abandoned her in her helpless old age. I suppose mother feared we might do the same to her. And two of her companions had undergone surgery for colon cancer and had had colostomies. They were graphic about the difficulties they had undergone.

That was all our mother knew about colostomies. So now she would "think about" her own tumor until it obstructed and would no longer be easily curable. She refused all our attempts to introduce her to a member of the local hospital's "ostomy team" who could give her a more cheerful second opinion.

Of course her internist knew that mother's first "I'll think about it" was a polite refusal. Other old ladies had often used the same phrase when they were eager to get out of the office and seek a second opinion. But he was confident that with a little pressure from the family and more information about the consequences of leaving her tumor alone she would accept the recommended treatment. He did not solicit our help until she had repeatedly fallen into her customary defence.

So my brother and I left our flourishing practices, my two sisters took emergency leave from their positions as nursing supervisors, and we all descended together on our old hometown to persuade mother to accept surgery.

We could not persuade her. We reasoned, we described, and we grew angry in an attempt to make her shout back, hoping that anger might, in its cooling, lead her to yield to us, for we knew more than she did about the consequences of her refusal.

You can imagine how frustrating this was. It is bad enough when an elderly relative who should be becoming more and more dependent with time ignores the sound advice, counsel and help of rising and highly competent progeny. It is worse when the progeny are knowledgeable medical personnel.

Our failure to convince her was particularly galling because we knew her disease was curable, very probably without the inconvenience of a colostomy. But she wasn't buying that. The experts at the senior center had told her that it was common practice for doctors to entice patients to the operating Table withpromises of segmental resection only to find that the lesion was either too extensive or the blood supply too compromised to permit the proposed operation. Her two friends who had gone in for colon resections had ended up with colostomies. That was enough for her. Her anecdotal evidence consisted of two cases.

We explained the dangers of depending on evidence based on a statistically insufficient sample. We offered to pay her way to the Mayo Clinic for a more authoritative second opinion. In vain. She said she would think about it. My mother already had her sources of information and she believed them.

In desperation, all four of us gathered around her recliner in the menacing manner of mafia hit men and "leaned" on her. But all we got was another bland "I'll think about it." Ours was an offer she found easy to refuse.

We thought of force, of legal action. But our mother was perfectly competent mentally. There was no way we could certify her as incapable. Any judge would have laughed us out of his chambers or fined us for abuse of process had we gone to him for an order requiring her to submit to the safe, effective, and curative surgery she required.

I have already said that although our mother liked everyone and took a fascinated interest in every life story she was also more than a bit of a snob. She liked everybody but respected very few. Aside from my father, now dead, and the obstetrician who had delivered her of us, also now dead, she respected only former Justice Blackmun of the Supreme Court and Bernard Ylvisaker, the Professor Emeritus of Philosophy at Preus, the local college. It had occurred to me by now that she did not really respect any of us children, much as she loved us and as proud of us as she was. Perhaps Professor Ylvisaker, who had been a colleague of my father's, and was even older than she was, would be more successful in persuading her to accept surgery. So I made a point of visiting the old man in his dusty study in the shabby little house he had built 50 years ago just off campus at One Preus Drive. He understood my mission at once.

"It might help," he said, "that I have a colostomy myself. It's nowhere near as dreadful as your mother thinks. In fact, it's rather convenient. Its care can be scheduled and unlike most of my former colleagues, I'm never constipated."

Professor Ylvisaker was a dream come true. He had said just the right thing, for, as I have mentioned before, mother was constipated. She considered it the greatest affliction of her old age, and, whenever we visited, she regaled us at greater length than we liked about her trials with her bowels. She insisted constipation was painful and thus went to great lengths to ensure a daily movement whether or not she had eaten enough to justify one. Every one of her many laxatives had been found wanting. The enema bag received constant use. And often she resorted to manual extraction with a finger cot. The one thing that might persuade her to risk a colostomy was the delightful side effect of no more constipation.

And so it proved. After her tete-a-tete with Professor Ylvisaker, mother willingly, almost eagerly, signed the permission we had been thrusting at her all week, and underwent her surgery. It was quite uneventful. The lesion, although showing foci of carcinoma in situ, was noninvasive. Unfortunately, her expectations went unfulfilled, for the surgeon was easily able to reanastomose her colon to the rectal stump. She was constipated until she died in her sleep 6 years later.