My grandma caught this fish sometime during the 1930’s while fly fishing back in Missouri with a 2 pound line. She died about two years ago. The last five years of her life weren’t too pretty. She just didn’t seem to enjoy much of her time. Her medical care was aggressive. Her doctor and the local hospital made hundreds of thousands of dollars off her demise.
Atul Gawande’s latest piece in the New Yorker called Letting Go really hit home. When I was a pediatric resident, I was fortunate enough not to have to witness too much death. But I’ll never forget the conversation I had with a family of a dying patient of mine. It was simply time to let that little guy go. At the end of the conversation, they realized it too. Being a good doctor is about knowing when to stop. It’s about admitting “defeat” from the brainwashing we get in medical school and residency– to prolong life at all costs.
Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives…
Technology sustains our organs until we are well past the point of awareness and coherence. Besides, how do you attend to the thoughts and concerns of the dying when medicine has made it almost impossible to be sure who the dying even are? Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly?
The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.
In order to have a sustainable healthcare system for the future, all doctors need to think like hospice workers. The goal for healthcare shouldn’t be about prolonging life…it should be about prolonging happiness and meaning.
Please take some time and read this article. You’ll need it one day.