understanding of the limits and the possibilities of
medicine is a process, not an epiphany.
There is no single way to take people with terminal
illness through the process, but there are some rules,
according to Block. You sit down. You make time.
You’renotdeterminingwhethertheywanttreatmentX
versusY.You’retryingtolearnwhat’smostimportantto
themunderthecircumstances—sothatyoucanprovide
informationandadviceontheapproachthatgivesthem
theirbestchanceofachievingit.Thisprocessrequiresas
muchlisteningastalking. Ifyouaretalking morethan
half of the time, Block says, you’re talking too much.
The words you use matter. According to palliative
specialists, youshouldn’t say,“I’msorrythingsturned
out this way,” for example. It can sound like you’re
distancingyourself.Youshouldsay,“Iwishthingswere
different.”Youdon’task,“Whatdoyouwantwhenyou
aredying?” You ask,“If time becomesshort, what is
most important to you?”
Blockhasalistofquestionsthatsheaimstocoverwith
sick patients in the time before decisions have to be
made: What do theyunderstandtheir prognosis to be,
whataretheirconcernsaboutwhatliesahead,whatkinds
oftrade-offsaretheywillingtomake,howdotheywant
tospendtheirtimeiftheirhealthworsens,whodothey
want to make decisions if they can’t?
Adecadeearlier,her seventy-four-year-oldfather,Jack
Block, a professor emeritus of psychology at the
UniversityofCaliforniaatBerkeley,wasadmittedtoa
SanFranciscohospitalwithsymptomsfromwhatproved