Americans don't know how to die  JUL 29 2010

Atul Gawande's articles on healthcare for the New Yorker are all top-shelf, but his most recent piece on modern medicine's difficulty in dealing with patients who are likely to die is a doozy and a must-read.

Almost all these patients had known, for some time, that they had a terminal condition. Yet they-along with their families and doctors-were unprepared for the final stage. "We are having more conversation now about what patients want for the end of their life, by far, than they have had in all their lives to this point," my friend said. "The problem is that's way too late." In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one's final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or "It's O.K." or "I'm sorry" or "I love you."

Warning: it's good, but you'll probably be crying by the end of this article.

Update: Shoshana Berger on How to Die in 5 Easy Steps.

My father didn't die nearly so well. At 74, after a 50-year career as a professor of mechanical engineering, he lost his mind. At first he'd cover his mistakes with jokes-a forced punch line after slipping up on calculating the tip at dinner. Have you noticed how forgetful he's getting? His second wife whispered to me in the kitchen after a family meal. I hadn't. But it wasn't long before his colleagues politely suggested that it was time for him to retire. He'd been spotted in the elevator, the doors opening and closing repeatedly, as he stood there incapable of deciding which button to push. He could no longer locate his car in the lot. The faculty feared he was a danger to himself. Not long after, my father left his office; it's piles of professional journals and papers, and the poster hung on the back door, "I'M GOING TO BE AN ENGINEER LIKE MY MOM," expecting to be back.

Read more posts on kottke.org about:
Atul Gawande   death   healthcare   Shoshana Berger

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