One of the reasons I write is
it gives me my chance
to dive into problems
that I'm very confused about.
I've written about, you know,
"What are we supposed to do
about the cost of health care?
"Why is the malpractice system
so crazy
and what's the way
it should be?"
I've written about,
"Why do we itch?"
You know, if it's confusing
and interesting to me,
writing is my way of diving in
and figuring out what to
at least think about it.
And this was one
of the big ones.
The two big unfixables
are aging and dying.
You know, they're not...
You can't fix those.
We're afraid of talking
to the patient
about these problems as well.
A lot of doctors feel like,
"I know how to have
this conversation.
I know exactly what I'm doing."
But what I knew, what I could
see over and over again,
was that we weren't particularly
good at handling people
going through the last days
of their life.
I've had to learn that
because of patients
with whom, you know,
they did not end up
with a good experience at all.
And then I've had to learn it
the hard way because of my dad.
Do you remember when Dad first
started to get pain in his neck?
Instead, what they found was
a tumor-- a huge tumor.
I remember I took notes
in my journal around that time.
This is my dad saying,
"The way things are going,
I could be bedridden
in a few months."
The tumor had extended
into his midbrain.
The suggestion was that
we should go see
what options there might be
for chemotherapy.
So the oncologist lays out
eight or nine different options,
and we're swimming
in all of it.
Temozolomide, vincristine,
vinblastine.
And my dad says, "Well,
what if I don't take any?"
And she said,
"Well, that's your choice."
Then she started talking
about how, you know,
"You really should think
about taking the chemotherapy.
"Who knows?
You could be playing tennis
by the end of the summer."
And that was crazy.
It made me very mad
because it was...
Completely not right, yeah.
This guy is potentially
within weeks of being paralyzed.
It was holding out a hope
that was not a realistic hope
in order to get him
to take the chemotherapy.
The oncologist was being
totally human,
and the oncologist
was talking to my dad
the way that I had been talking
to my patients for ten years.
But hope is not a plan.
And in fact,
we find from our trials
that we are literally
inflicting therapies on people
that shorten their lives
and increase their suffering
out of an inability
to come to good decisions.
