Atul Gawande has a new article about how our health system does a bad job at end-of-life issues, and how hospice care is really a pretty good idea if the patient wants it, and how really the most important thing is to decide what kind of treatment you want before something terrible happens. WARNING: really really depressing! Here’s a good summary:
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.
More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, “You let me know when you want to stop.” All-out treatment, we tell the terminally ill, is a train you can get off at any time—just say when. But for most patients and their families this is asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. But our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.
To cheer you up, here are all the title sequences to Doctor Who played back to back.
I had lunch at California Pizza Kitchen today and they were running an interesting promotion. When the waitress gave me the check, she also gave me a “thank you card”, which had some sort of prize in it (probably 10% off a meal, but first prize is $100000). She then explained how it worked: I had to bring the card back next time I ate there and a manager would open it for me and reveal the prize inside (if I opened it on my own it was void). Also, if I won one of the big prizes, she (my waitress today) would get a share of it.
This struck me as a pretty clever gig: since you already have the card, it makes you want to go back to see if you’re “already a winner”, even though that’s basically equivalent to getting a card next time you go and opening it then. You can also feel good about potentially helping your waitress, I guess? That part was a little weird.