Thesimpleviewisthatmedicineexiststofightdeathand
disease,andthatis,ofcourse,itsmostbasictask.Death
is the enemy. But the enemy has superior forces.
Eventually,itwins.Andinawarthatyoucannotwin,
youdon’twantageneralwhofightstothepointoftotal
annihilation.Youdon’twantCuster.YouwantRobertE.
Lee,someonewhoknowshowtofightforterritorythat
can be won and how to surrender it when it can’t,
someonewhounderstandsthatthedamageisgreatestif
all you do is battle to the bitter end.
Moreoften,thesedays,medicineseemstosupplyneither
CustersnorLees.Weareincreasinglythegeneralswho
marchthesoldiersonward,sayingallthewhile,“Youlet
meknowwhenyouwanttostop.”All-outtreatment,we
tell theincurably ill,is a trainyou cangetoff atany
time—just say when. But for most patients and their
familiesweareaskingtoomuch.Theyremainrivenby
doubtand fearanddesperation;somearedeludedbya
fantasy of what medical science can achieve. Our
responsibility,inmedicine,istodealwithhumanbeings
as they are. People die only once. They have no
experiencetodrawon.Theyneeddoctorsandnurseswho
arewillingtohavetheharddiscussionsandsaywhatthey
haveseen,whowillhelppeopleprepareforwhatisto
come—andescapeawarehousedoblivionthatfewreally
want.
SARAMONOPOLIHADhadenoughdiscussionstolether
family and her oncologistknow thatshe did not want
hospitalsor ICUs attheend—but not enough tohave
learnedhowtoachievehergoal.Fromthemomentshe
arrivedin theemergency roomthat Friday morningin