sincethenineties thenumbershavereverseddirection.
Useofhospicecarehasbeengrowing steadily—tothe
point that, by 2010, 45 percent of Americans died in
hospice.Morethanhalfofthemreceivedhospicecareat
home, and the remainder received itin an institution,
usuallyan inpatienthospice facilityforthe dyingor a
nursinghome.Theseareamongthehighestratesinthe
world.
A monumental transformation is occurring. In this
countryandacrosstheglobe,peopleincreasinglyhavean
alternativetowitheringin oldagehomes anddying in
hospitals—and millions of them are seizing the
opportunity.Butthisisanunsettledtime.We’vebegun
rejectingtheinstitutionalizedversionofaginganddeath,
but we’ve not yet established our new norm. We’re
caughtinatransitionalphase.Howevermiserabletheold
systemhasbeen,weareallexpertsatit.Weknowthe
dancemoves.Youagreetobecomeapatient,andI,the
clinician, agree to try to fix you, whatever the
improbability,themisery,thedamage,orthecost.With
thisnewway,inwhichwetogethertrytofigureouthow
tofacemortalityandpreservethefiberofameaningful
life,withitsloyaltiesandindividuality,weareplodding
novices.Wearegoingthroughasocietallearningcurve,
onepersonatatime.Andthatwouldincludeme,whether
as a doctor or as simply a human being.
MYFATHERWASinhisearlyseventieswhenIwasforced
torealizethathe mightnotbeimmortal.He’dbeenas
healthy as a Brahma bull, playing tennisthree days a
week,maintainingabusyurologypractice,andservingas
presidentofthelocalRotaryClub. Hehadtremendous