AND IN THE END

Posted in Rants on August 24th, 2015 by Ed

It can't be easy for anyone to hear a cancer diagnosis. It must be especially difficult to hear when you are 90 years old. Being 90 is a pretty lethal condition on its own; pairing it with one of the leading causes of death in the industrialized world must make the end feel very, very near. It's not an irrational feeling either. The end is getting near.

When I heard that 90 year old ex-president Jimmy Carter had signs that his cancer had spread to both his liver and his brain I was saddened. I like Jimmy Carter, and the news was as close to a straight death sentence that I could imagine for a man of his age. Which is why I was somewhat surprised to hear that he is choosing to undergo radiation treatments. Obviously he is the patient and it's his choice entirely; if he wants to pursue that course, he should. I'm curious, though, to know what endgame he foresees. Does he expect to "beat" cancer in his brain and liver? I've heard that radiation therapy doesn't make one feel terribly well, if I may engage in wild understatements. Does he hope that this will extend his life briefly, trading quality for quantity? Frankly he doesn't seem like the type of person so fearful of death that he would pursue that. Again, it's none of our business what he wants to do, but it's a good example of one of the hundreds of flaws with the system of healthcare in this country.

I am privileged to call some medical professionals friends, and they anecdotally confirm what repeated studies of American hospitals show: a great deal of the money and resources expended by our healthcare system are expended futilely. In some cases doctors and nurses know that it is futile; in others they are responding to patients' desire to exhaust treatment options when the potential benefits are minuscule and highly unlikely. Has any end-stage terminal cancer or cardiovascular patient ever benefited for more than a fleeting moment from being put on a mechanical ventilator? I suppose the medical literature could be scoured to find one.

As people so often do, I remember clearly being in the hospital when the only one of my grandparents I had any sort of relationship with died. According to what must have been hospital protocol, they prepared to use an injection of (adrenaline? something that re-starts hearts?) and a defibrillator on her. She was a massively overweight woman who had been confined to a hospital bed for months, slowly dying of congestive heart failure while hooked to various machines. The idea of trying to resuscitate her struck me, even at 15, as a ludicrous farce. My father asked, "Doctor, is my mother dead?" Yes. "Then what the fuck are you doing? She's dead." I mean, what was the best case scenario there? She lives another eight hours and then they do it again?

That is a question that seems to be asked infrequently in our medical culture. By all means, patients should have access to whatever treatment they and their doctors decide to pursue. And I know doctors are deeply frustrated by the insistence of patients (or families) to do things that are obviously futile. I envision every conversation with or about a terminal patient like Jim Carrey in Dumb & Dumber; the doctor says "The odds of recovery are one in a million," followed by, "So you're saying there's a chance!"

Nobody knows how they will react to being in such a jarring dilemma until it happens. It's easy to say "No way, I'd just pull the plug!" when you've never had to make that choice outside of hypotheticals. I also recognize that I'm not the best person to opine on this matter, given that I'm ready to call Dignitas during the average chest cold. And who knows, perhaps Jimmy Carter will experience a remarkable remission and go on to live many more years. I don't have a practical solution; I wish we could create some kind of system that would allow medical professionals to be as honest as possible (rather than erring on the side of avoiding a lawsuit) to patients who were capable of understanding the futility of spending gobs of money on the lightning strike odds that some treatment will buy them a few more days alive in the ICU.