Waco Tribune-Herald - March 06, 2012New Search
Waco Tribune-Herald (TX) - Tuesday, March 6, 2012
Author: MICHAEL ATTAS
past week three different sources told me what was essentially the same story
seen through totally different lenses.
On Ash Wednesday, my pastor began his sermon by looking around to those gathered for the beginning of Lent and spoke loudly and forcefully words intended to shock us out of our complacency.
“You are dying” he said. “You are dying. And the only difference is that some of you know it and have been given a specific diagnosis and a general time line, and others of you don’t.
“But rest assured. It is happening.”
We silently came forward later in the service to have the ashes placed on our foreheads, hearing the solemn words that bring it all home: Remember that you are dust and to dust you shall return.
Leaving in silence and darkness, one cannot help but get a good reality check about our shared fate.
Two days later, I received a tender, quiet email from a colleague at Baylor University who recently was diagnosed as having terminal pancreatic cancer.
He may have six months to live, but he wanted to thank me for a workshop I led at his church many years ago on the major difference between healing and curing.
Healing is possible
Healing, I reminded them, is possible even as we walk through the valley of the shadow of death. It is possible when curing is painfully absent.
And in his words, I saw courage in the face of darkness, love in the place of despair and acceptance of the words I heard my pastor say only two nights before.
Yes, we are dying. My friend has chosen only basic palliative care and will actually go quite gently into the good night. He will not rage at the injustice of it, and I am sure that he will die with the peace and dignity with which he has lived.
Yes, I am dying, he said to me. Yes, we all are.
The third of the “messages” was an article that a dozen or more friends forwarded to me at about this same time. It was published in the Wall Street Journal and was headlined “Why Doctors Die Differently.”
The thrust of the article was the rather amazing and very true statement that doctors — who surely have access to all of the latest clinical and research trials and cutting-edge technology — often forgo those when faced with terminal illness and choose to die simple deaths surrounded by loved ones. Just let it be what it will be.
The article confirmed what I have observed in 40 years of medicine. The most aggressive and unending treatment options are often chosen by those who have been the most disenfranchised by medicine for most of their lives.
The higher the education and socioeconomic standard of the patient, the more they want to simply die with minimal heroic measures.
And the people who have been pushed to the margins most of their lives often want “everything done,” even when the medical team knows it is wasted effort.
Health care cost
So where does that lead us? An alarming set of data confirms that 25 percent of our national health care expenditures comes in the last 30 days of life, when we know the outcome is futile.
As a nation, we are squandering precious resources refusing to accept the fact that my pastor and friend both freely acknowledge.
We are dying. We are dust. And to dust we shall return.
It is a collective Lent reminder of our shared mortality.
Yet we continue to insist that all diseases can be conquered, death can be squelched, and if we only pour enough resources into health care we can avoid our certain fate.
Our minds tell us otherwise, of course, and deep down we must certainly know better.
What can be done? For starters, I believe we must have a calm, respectful, loving and rational national conversation about end-of-life expenditures and issues.
It must be done without one side accusing the other of “death panels.”
It must be done without inflammatory rhetoric and threats of catastrophe or socialism.
We cannot continue to avoid realities in this part of health care. We have abundant resources and are simply not using them wisely.
Yes, we must be cautious about turning these decisions over to congressional committees and legislation.
But yes, we also must be cautious about turning them over to corporate board rooms and stockholders.
And, yes, we must be careful about turning a blind eye and saying “let’s just leave it to the marketplace and the sanctity of the physician-patient relationship.”
Trust me, we have neither the collective wisdom nor access to all of the facts we need to make a wise decision about many of these things. Together, we must face the fact that we are in a Lent of our national life about health care issues and expenditures.
We must face these together — and wisely — or surely we will all fail together in our efforts to provide compassionate care for our society.
It is Lent, and to dust we return.
Dr. Michael Attas is a Waco-based physician, a medical humanities professor and an Episcopal priest. His column appears on a biweekly basis. Send email to [email protected]
Record Number: 17966898
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