That Good Night

Oh how I wish Dr. Sunita Puri has written That Good Night when I was a resident at the Univ. of IA Hosp. & Clinics back in 1979. It grew out of my need to answer a question. When returning to the hospital after a weekend often patients with life limiting conditions had been discharged and I wondered what would happen to them. That led me to wonder with others and ensued our effort to create a home care hospice in the early 1980’s when hospice was a new idea in this country.  As I immersed myself in her memories, my own memories came flooding back. When I read that the American Board of Medical Specialties didn’t recognize hospice and palliative medicine as s distinct medical sub-specialty until 2006 a lot of my questions began to make sense. Seeing from behind her eyes helped me to see how difficult modern medicine is for people whose whole identity is to fix things. At some level I knew this, but at another level it seemed unreal. On my first night as a resident chaplain I distinctly remember the terror I felt as my pager went off and I headed down the long darkened hall toward what I hoped was the right direction. At the end of the hall I could see the shape of someone and I imagined it to be the Spirit and found myself mentally shouting “I will had you what I can reach.” This moment of truth, for someone short enough to spend a lot of time asking people to reach things for me, freed me to enter into the chaos that awaited me. As long as I truly handed to those in need whatever I could reach, I could fail and still come out OK.  Dr. Puri says this in so many eloquent ways there would be no way to list them all. As medical options become ever more complex, the questions of what should be done become ever more difficult. I hope that all people walking the paths with patients might find this book and bring her wisdom into their lives. It is interesting that her whole lifetime is the very length of time I have been invited to share the struggles of patients and their families. In a way I feel like Simeon in Luke’s gospel saying “Master, now you are dismissing your servant in peace, according to your word: for my eyes have seen your salvation, which you have prepared in the presence on all people, a light for revelation to the (caregivers) Gentiles and for glory to your people Israel.” Luke 2: 29-32.

Being Mortal

It is a rare book that has me mentally shouting YES almost on every page, but Being Mortal by Atul Gawande has done that for me.  After serving people who are trying to make sense out of the modern medical systems for so many years, it was a source of hope and joy to read this book. Taking into consideration the whole person who is trying to make their way through the bewildering options now available is the new frontier and it is the new “wild west”. Never in human history has so many questions of what it means to be human challenge us now. The physical, emotional, psychological and spiritual questions come at us at a pace that overwhelms the best of us. Reading this book and talking with our significant others is a great first step. Dr. Gawande tells the stories in a way that will help us recognize our own stories. He will be an able guide as we each confront Being Mortal.

Since I read this book the author was inter vied on Public radio and said this:

“There are many kinds of studies; the most powerful one, for me, was the study that Jennifer Temel, a Massachusetts General Hospital physician, did — led, which took care of stage four lung cancer patients. They lived only, on average, 11 months. It’s a terminal condition; no one lived past about three years. And what she did was, half of the group were randomized to get the usual oncology care, and the other half were randomized to get the usual oncology care plus a palliative care clinician, physician, to see them early in the course of their illness. And so it was sort of a radical idea — see them from the very beginning.

And what — the group who saw the palliative care clinicians from the very beginning did end up stopping their chemotherapy. They were 50 percent less likely to be on chemotherapy in their last three months of life. They were 90 percent less likely to be on the chemotherapy in their last two weeks of life. They were less likely to get surgery towards the end. They had one-third lower costs. They started hospice sooner. They spent more time out of the hospital. They were less likely to die in the hospital or die in the ICU. And the kicker was that they not only had overall less suffering, they lived 25 percent longer.”

You can listen to or read the entire interview here