From an article by Atul Gawande that appeared in the New Yorker last year (long, but well worth the read):
This is a modern tragedy, replayed millions of times over. When there is no way of knowing exactly how long our skeins will run—and when we imagine ourselves to have much more time than we do—our every impulse is to fight, to die with chemo in our veins or a tube in our throats or fresh sutures in our flesh. The fact that we may be shortening or worsening the time we have left hardly seems to register. We imagine that we can wait until the doctors tell us that there is nothing more they can do. But rarely is there nothing more that doctors can do. They can give toxic drugs of unknown efficacy, operate to try to remove part of the tumor, put in a feeding tube if a person can’t eat: there’s always something. We want these choices. We don’t want anyone—certainly not bureaucrats or the marketplace—to limit them. But that doesn’t mean we are eager to make the choices ourselves. Instead, most often, we make no choice at all. We fall back on the default, and the default is: Do Something.
Last week, my pastor at CCFC remarked how there is a disconnect in between how Hollywood portrays the process of death and how it actually occurs in real life. Even a person who dies in a violent or graphic manner somehow manages to go in a relatively quick and graceful fashion. But very rarely does a perfectly healthy person quietly pass in the night. Instead, there is often an uncomfortable and unglamorous deterioration cycle that seems to accelerate as a person ages. People collect diagnoses like basketball cards, trading up and down and exchanging this for that as they enter a carousel of hospitals and rehab centers and skilled nursing facilities, never completely recovering from one injury before having to endure the next.
It would be impossible to spend any amount of time with medically fragile patients, the youngest of whom are in their 70s, without thinking about end of life issues. Indeed, in the past 6 weeks, 3 people on my caseload have died.
My first encounter with death of a patient occurred during my first week. Rather, she “expired” due to a “failure to thrive.” In her final days, her body’s systems were breaking down, she wasn’t eating, and she was barely conscious, even when awake. In crude, unfeeling terms, she was circling the drain.
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