July 28, 2010
Myra has us all reading Atul Gawande’s August 2nd piece in the New Yorker. Remember, he’s a physician, so when he says, “Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left,” I know he’s pointing his finger at the medical profession.
But I think we “recipients” of today’s medicine share equal blame.
We are too often not ready to hear that our time is almost up. And under what conditions are we able to let go? One story he tells is that of a daughter who hears her father say, “As long as I can eat chocolate ice cream and watch football on TV, I am willing to stay alive.”
And the daughter, of course, is the surrogate, so place those instructions into the mix when one tries to ascertain the “breakpoint discussion” when “dying” is the operative word.
Dr. Gawande cites the LaCrosse, Wisconsin story (which many of us know) where, since 1991 the entire city has been flooded with injunctions to have the “caring conversation” and it has worked! (By 1996 85% of the residents there who had died had written advance directives!)
So I think of the 26 year history of the Center and all the words we have addressed on end-of-life issues to thousands of our citizens, and I wonder why Kansas City isn’t another LaCrosse.
And it’s not just physicians who are slow to recognize that the end is near; it’s we who savor that chocolate ice cream!
But we can’t stop addressing that the end is inevitable.
Labels: end of life; medical ethics; medical futility; palliative care; advance care planning