MODERNSCIENTIFICCAPABILITYhasprofoundlyaltered
thecourseofhumanlife.Peoplelivelongerand better
thanatanyothertimeinhistory.Butscientificadvances
haveturnedtheprocessesofaginganddyingintomedical
experiences, matters to be managed by health care
professionals.Andweinthemedicalworldhaveproved
alarmingly unprepared for it.
Thisrealityhasbeenlargelyhidden,asthefinalphasesof
lifebecomelessfamiliartopeople.Asrecentlyas1945,
mostdeathsoccurredinthehome.Bythe1980s,just 17
percentdid.Thosewhosomehowdiddieathomelikely
diedtoosuddenlytomakeittothehospital—say,froma
massiveheartattack,stroke, orviolentinjury—orwere
too isolatedto getsomewherethatcouldprovidehelp.
Across not just the United States but also the entire
industrialized world, theexperience ofadvanced aging
and death has shifted to hospitals and nursing homes.
WhenIbecameadoctor,Icrossedovertotheotherside
ofthehospitaldoorsand,althoughIhadgrownupwith
twodoctorsforparents,everythingIsawwasnewtome.
IhadcertainlyneverseenanyonediebeforeandwhenI
diditcameasashock.Thatwasn’tbecauseitmademe
thinkofmyownmortality.Somehowtheconceptdidn’t
occurtome,evenwhenIsawpeoplemyownagedie.I
hadawhitecoaton;theyhadahospitalgown.Icouldn’t
quitepicture ittheotherway round.Icould,however,
picturemyfamilyintheirplaces.I’dseenmultiplefamily
members—my wife, my parents, and my children—go
through serious, life-threatening illnesses. Even under
dire circumstances, medicine had always pulled them
through.Theshocktomethereforewasseeingmedicine