When Life Must End

“You must live in the present, launch yourself on every wave, find your eternity in each moment. Fools stand on their island of opportunities and look toward another land. There is no other land; there is no other life but this.”
― Henry David Thoreau

I know many doctors who are ICU specialists.  Not one of them would give permission for another doctor to place them in an ICU for weeks at a time.  They understand that after reasonable efforts have been made the chances for meaningful survival are slim to none.

Yet we know that a large percentage of medical expenses are incurred within a few months of a patient’s death.  Meaning that patients or their families choose to prolong life at all costs (financial and emotional).  What gives?  Why is it so hard for doctors to communicate the futility of care?  And why are patients and families so invested in prolonging treatment that is painful, expensive, and futile?

Of course the answers are complicated.  I think that a major cause is that the general public has a very limited grasp of the meaning of statistics.  People gamble (at the casino, and the races, and buying lottery tickets) to the tune of many billions of dollars a year.  They honestly feel that they have a chance to win.  These false senses of security are reinforced by the press and the people who earn their living from gambling.  Of course they want you to continue to throw your money away.  We see someone on TV that just won 50 million dollars, and we are willing to ignore probability in order to assume that the next “lucky” number will be ours.

So if the odds of winning the lottery are 50 million to one, and the odds that mom will walk out of the ICU are a hundred to one, we begin to think that mom has a great chance to survive.  Because her chances are so much better than at the lottery.  Over the years I’ve treated hundreds of families that feel that 5% are good odds, and are willing to go to incredible lengths to prove themselves right.

Communication is a problem.  Most primary care doctors no longer assume responsibility for their hospitalized patients.  The doctors who take over do not know the patient or the family.  No treatment fits all.  A patient without support systems (family; friends; church, money; transportation) won’t do well if he has to monitor blood sugars four times a day and drive to get therapy three times a week.  Many times the people who promise to help don’t come through.  Patients end up coming in and going out of hospitals at unbelievably high frequency.  Each admission is like taking a step down a spiral staircase.  Eventually the patient stumbles and falls.

Many of us are “pleasers.”  Even when it comes to life or death we make decisions based on what we think somebody else wants us to do.  Children with a large burden of guilt may demand that dad be kept alive no matter what.  In turn dad may feel touched that a son that has neglected to keep in touch for years is now so interested in his survival.  The wheel keeps turning.

I could go on for fifty pages, but you get the idea.  The sad part of all of this is that the person who matters the most, the one who’s doing all the suffering and paying the bills, is too often the one whose interests and welfare are thrown to the wolves.  We have unreasonable expectations about sickness and medical therapies.  We forget that the 95% survival rate for a procedure may be 40% survival in an elderly person with multiple problems. 

We neglect ourselves and our souls; we overeat and underexercise and forget to love our existence and the family and friends that make it possible for us to enjoy it.  We don’t live, and when the time comes to depart from this world we wonder if maybe this is not our train, because we have so much that we never got to do.  And we cling.

You’ve heard this a million times.  Here it comes again.  Today is your last day.  Make sure that everyone you deal with; every new soul that you meet will miss you if you’re not here tomorrow.  Have you done your best for your spouse or significant other?  Are there any loose ends that you never got around to trimming?

There will be no redo.  Today is your last day.  Make it count.

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This Post Has 5 Comments

  1. We can spend a lot of time and money planning a trip to the other side of the world, but many of us do not plan the long lasting trip, our own funeral. When I start talking about this to my children they are somewhat surprised that I bring the subject. “Do you expect me to take care of you?” “In my house?”. At least my daughter told me that surely she would. My son said that Boston is very expensive, and too cold for me. Maybe he is right, but I told him that by that time I would probably be in a wheel chair or bed ridden, and all things considered maybe Boston could be more comfortable. He said kindly enough, “I’ll look into it if you want me to.” I told him, kind of jokingly, that whoever takes responsibility will win the jack-pot. “Well, I’m just rehearsing. But still think I have to make sure that I review my living will soon.” The laws of Puerto Rico provide that your children inherit two thirds of your estate, and you have one third of free disposition. It will only be fair to give that third to the one that takes care of you, being in a home, or in their own house. All being considered, I wish to be cremated and have bought my own space in the Church in Palmas del Mar, where I live. At least that has been taken care of. I have signed to donate my organs, and have instructed that I wish to be unconnected as soon as the doctors see fit. Not to spend time or money to prolong pain, uncomfort and sorrow.

  2. Javier Alberdi

    Querido Paco: Lo que me llama la atención cada vez más es que la visión de la vida que nos transmitieron muchos de nuestros maestros en la vida tiene un montón de aspectos que son reales y signos de valoración. El envoltorio en que nos lo dieron me resulta francamente inaceptable. Tu artículo se podría poner en una charla sobre la muerte en unos ejercicios espirituales… la pena es que se añadían otro montón de cosas, que no tienen ni pie ni cabeza. Un abrazo. Javier

    2013/2/25 Francisco Garriga, M.D.

    > ** > franciscogarrigamd posted: “I know many doctors who are ICU > specialists. Not one of them would give permission for another doctor to > place them in an ICU for weeks at a time. They understand that after > reasonable efforts have been made the chances for meaningful survival are > slim “

  3. Linda

    Wow – hadn’t thought of it that way before! Thanks for your insight!

    1. Maybe this is a conversation that needs to continue. Will think of adding another blog soon. Thanks for your encouragement.

  4. Cordell Webb

    I always try to make everyday count.
    My wife and I have made our funeral arrangements at our local funeral home. We both plan to be cremated. Just a memorial service for friends and family. We have both picked out music and scripture to be used. I feel this makes it much easier for our children to deal with it at the time. We both do not want to be hooked up to machines or whatever when our time comes. Our children know this also. I would like for my primary care doctor to be the one to advise our families.
    Footnote, A close friend is going thru this very thing. She is close to their primary doctor because they have known him and cared for her husband for more than 20 years. She feels comfortable with his advise.