responsibilitiesofamoderndoctor.Wewere confident
that in such a situation we would act compassionately.
Whatworrieduswasknowledge.Whileweknewhowto
sympathize, weweren’t atall certain we wouldknow
howtoproperlydiagnoseandtreat.Wepaidourmedical
tuitiontolearnabouttheinnerprocessofthebody,the
intricatemechanismsofitspathologies,andthevasttrove
ofdiscoveriesandtechnologiesthathaveaccumulatedto
stopthem.Wedidn’timagineweneededtothinkabout
much else. So we put Ivan Ilyich out of our heads.
Yet within a few years, when I came to experience
surgical training and practice, I encountered patients
forcedtoconfronttherealitiesofdeclineandmortality,
anditdidnottakelongtorealizehowunreadyIwasto
help them.
IBEGANWRITINGwhenIwasajuniorsurgicalresident,
andinoneofmyveryfirstessays,Itoldthestoryofa
man whom I called Joseph Lazaroff. He was a city
administratorwho’dlosthis wifeto lungcancer afew
years earlier.Now, hewas inhis sixtiesand suffering
from an incurablecancer himself—a widelymetastatic
prostatecancer.Hehadlostmorethanfiftypounds.His
abdomen, scrotum,and legshad filled with fluid.One
day,hewokeupunabletomovehisrightlegorcontrol
hisbowels.Hewasadmittedtothehospital,whereImet
himasaninternontheneurosurgicalteam.Wefoundthat
thecancerhadspreadtohisthoracicspine,whereitwas
compressing his spinal cord. The cancer couldn’t be
cured, but we hoped it could be treated. Emergency
radiation,however,failedtoshrinkthecancer,andsothe
neurosurgeonofferedhimtwooptions:comfortcareor