Stories: often the best way to learn about life and death
For me, the best way to figure out what I’m trying to figure out is through stories. I loved The Better End: Surviving (and Dying) on Your Own Terms in Today’s Modern Medical World by Dr Dan Morhaim, (Johns Hopkins University Press). It’s filled with stories from Dr Morhaim’s extensive career in medicine.
But first: The thing that took me by surprise was Dan Morhaim’s humility and courage: A doctor admitted to being conflicted in his experiences with life-prolonging interventions!
“I have several competing reactions: Sometimes I just rationalize: this is the system. I’m part of it, and I do my job as best I can. At other times, I get angry because of the agony we put patients through and because of the time, energy, money, and medical talent spent on treatment that neither cures nor comforts. Third, I feel guilty because I’m not taking steps to stop the process. Writing this book helps.”
Dr Dan Morhaim
Morhaim has a mind-boggling batch of responsibilities: Emergency and Internal Medicine physician, Deputy Majority Leader of the Maryland state Legislature’s House of Delegates, and Adjunct Professor in the Department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health. That he even had time to write “The Better End” is a statement of his commitment to a Better End.
Setting the stage in his introduction, “Then and Now”, Morhaim presents life and death a decade ago when there were no antibiotics, cardiac surgery, or medical devices: A 50 year old farmer died at home when pneumonia has set in after being bed-ridden with a worsening cold and a deteriorating heart. He lapsed into a coma and and died peacefully at home, surrounded by his family. 100 years later, the farmer’s great-grandson, Bill, was 75 when prostate cancer was first discovered and treated, and 83 when it returned – untreatable. In and out of hospital for 18 months, his last trip was for pneumonia, the same as his great granddad’s. Bill was treated for aggressively but died alone in the Intensive Care Unit of a hospital a day or two later – his liver stopped functioning and his heart gave out.
Then there’s Abby who decided she didn’t want any interventions for advanced cancer after several full courses of chemotherapy. Knowing the end was coming, she instructed, “I only want food and pain medicine, and if I get too weak to eat, I won’t want artificial feeding…. I ask that … Mick (her dog) be allowed to be with me as long as possible… I don’t want you to ever feel guilty. By following my instructions, you are showing your love for me.” Her son, Josh, is heartbroken that his mother doesn’t want to have an experimental treatment – he very much wants his mother to see her new grandchild. But Abby responds, “I have no control over when I’ll die, so I’ve made a DVD with things I’d like to impart to my grandchildren.”
Written for ‘real people’, many chapters cover helpful steps: Overview of Forms, Choosing the Kind of Care You Want, Selecting your Health Care Agent (aka Substitute Decision Maker, Surrogate Decision-Maker). The stories – actual case studies – serve to help understand the scenarios and decisions we may face, and that puts context to the concept of life-sustaining interventions and ultimately helps us to write meaningful end of life wishes.
This book has earned an endorsement on the front cover from renown author Maya Angelou. For me, that’s particularly big doings because of an Angelou quote that continues to resonate:
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
At 150 pages, “The Better End” is an easy read, and packed with smarts, insights, and empathy. It’s both thoughtful and thought-provoking.