End-of-Life Care

This article from the New Yorker (August ’10) hits home for me right now. But I come away from it still puzzled by the willingness of the doctors to keep treating even when they know there’s little to no chance of helping (and possibly even a good chance of making things worse).

This part stood out:

She absorbed the news [about her incurable cancer] in silence, looking down at the blankets drawn over her mutinous body. Then she looked up at me. “Am I going to die?”

I flinched. “No, no,” I said. “Of course not.”

A few days later, I tried again. “We don’t have a cure,” I explained. “But treatment can hold the disease down for a long time.” The goal, I said, was to “prolong your life” as much as possible.

I’ve seen her regularly in the months since, as she embarked on chemotherapy. She has done well. So far, the cancer is in check. Once, I asked her and her husband about our initial conversations. They don’t remember them very fondly. “That one phrase that you used—‘prolong your life’—it just . . .” She didn’t want to sound critical.

“It was kind of blunt,” her husband said.

“It sounded harsh,” she echoed. She felt as if I’d dropped her off a cliff.

Maybe it’s my hardened academic heart, but I find it hard to believe that people can be that sensitive. Not that I don’t believe the story—I do—but I think there’s something deeper going on with the patient than just the words her doctor used. I guess the challenge is in understanding what people are really feeling and responding to that rather than to the surface meaning of the words they say. I suppose it doesn’t surprise me that medical training leaves them unprepared for that. And I definitely don’t think I’d be any better at it.

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