The terminal failure of orthodox medicine

When my father died last year of cancer it took me some time to fully grasp the manner of his passing and to realise my own culpability in allowing the doctors to destroy whatever dignity death might have allowed him if I had had the courage and the knowledge to stop the torture.

I allowed the doctors to conduct nuclear war on a (clearly) dying 83-year-old man — what they described as “palliative” radiations. In my father’s case, and I believe in the case of many thousands more, such interventions can be a shocking, perverse form of professional “kindness” that is built into the orthodox medical machine that just does not (want to) know when to stop.

The result of their efforts was a death without honour for a man subjected to totally unnecessary radiation that almost immediately sapped the life-spirit from his body and soul, left him broken, unable to consciously bring closure to his life. I estimate the professionals pocketed about R80 000 for their handiwork in those last few weeks. In hindsight, I should have paid them triple just to let my dad die with some dignity.

The reality of all this came into sharp focus this week when I came upon a remarkable piece in the latest New Yorker magazine written by Atal Gwande, a surgeon/journalist (yes, there is such a species) with (literally) inside knowledge and acute insight into the treatment and care of terminal patients.

The Gwande piece, titled Letting Go, is not only relevant for those having to deal with the deaths of others, it’s about all of us confronting head-on our own deaths too. You may find this a little morbid, but the statistical chances of any one of us dying slowly from a degenerative illness such as cancer or heart disease are now so high that the Gwande article is, I believe, required reading for all sentient beings — those who are conscious of the finiteness of their lives but not the timing of their deaths — and who should — at sometime — prepare for this reality. Failure to do so will result in our epitaphs being written in a miasma of denial, ignorance and fear.

You can read the Gwande piece by clicking on this link.

I urge you to read the entire article as it develops a series of ideas built on numerous anecdotal experiences and case studies. After reading it I’m sure, like me, you will start the process of writing a living will, giving you some control over how to let life go.

Some quotes from Gwande article:

“We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets — and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan.”

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“Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop.”

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“Spending one’s final days in an ICU because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realising that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s OK.” or “I’m sorry” or “I love you.”

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“These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition — advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn’t. So everyone struggles with this uncertainty — with how, and when, to accept that the battle is lost.”

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“Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4 493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer.”