Status Updates From Being Mortal: Medicine and ...

“asking for chapatis, rice, curried string beans, potatoes, yellow split-pea dahl, black-eyed-pea chutney, and shira, a sweet dish from his youth. He talked to his grandchildren by phone. He sorted photos. He gave instructions about unfinished projects. He had but the tiniest fragments of life left that he could grab, and we were agonizing over them. Could we get him another one?”
I can’t stop crying

I am leery of suggesting the idea that endings are controllable.
No one ever really has control. Physics and biology and accident ultimately have their way in our lives. But the point is that we are not helpless either. Courage is the strength to recognize both realities.

I’m crying again

“In the end, people don't view their life as merely the average of all of its moments-which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens.”

The brain gives us two ways to evaluate experiences like suffering there is how we apprehend such experiences in the moment and how we look at them afterward—and the two ways are deeply contradictory.

“We witnessed for ourselves the consequences of living for the best possible day today instead of sacrificing time now for time later.“

The choices don’t stop, however. Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.

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 want someone who understands that the damage is greatest if all you do is battle to the bitter end.

The conversation that we all need to have when the chemotherapy stops working, when we face high-risk surgery, when we become unable to dress ourselves. I've heard Swedish doctors call it a "breakpoint discussion" a series of conversations to sort out when they need to switch from fighting for time to fighting for the other things that people value-being with family or traveling or enjoying chocolate ice cream.

“In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussions were an experimental drug, the FDA would approve it.”

Oof