When, as the researchers put it, “life’s fragility is primed,” people’s goals and motives in their everyday lives shift completely. It’s perspective, not age, that matters most. Tolstoy.
What is troubling is not just being average but settling for it. Everyone knows that average-ness is, for most of us, our fate. And in certain matters – looks, money, tennis – we would do well to accept this. But in your surgeon, your child’s pediatrician, your police department, your local high school? When the stakes are our lives and the lives of our children, we want no one to settle for average.
I see it now – this world is swiftly passing. – the warrior Karna, in the Mahabharata.
A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life;.
Spending one’s final days in an ICU because of terminal illness is for most people a kind of failure. You lie attached to a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said good-bye or “It’s okay” or “I’m sorry” or “I love you.
We witnessed for ourselves the consequences of living for the best possible day today instead of sacrificing time now for time later.
Ingenuity is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions.
Yet – and this is the painful paradox – we have decided that they should be the ones who largely define how we live in our waning days.
The body’s decline creeps like a vine. Day to day, the changes can be imperceptible. You adapt. Then something happens that finally makes it clear that things are no longer the same.
Human birth... is a solution to an evolutionary problem: how a mammal can walk upright, which requires a small, fixed, bony pelvis, and also possess a large brain, which entails a baby whose head is too big to fit through that small pelvis... in a sense, all human mothers give birth prematurely. Other mammals are born mature enough to walk and seek food within hours; our newborns are small and helpless for months.
International organizations are fond of grand-sounding pledges to rid the planet of this or that menace. They nearly always fail, however. The world is too vast and too various to submit to dictates from on high.
Assisted living most often became a mere layover on the way from independent living to a nursing home.
We’ve divided the world into us versus them – an ever-shrinking population of good people against bad ones. But it’s not a dichotomy. People can be doers of good in many circumstances. And they can be doers of bad in others. It’s true of all of us. We are not sufficiently described by the best thing we have ever done, nor are we sufficiently described by the worst thing we have ever done. We are all of it.
One wants to know whether, in the end, her troubles were physical or psychological. But it is a question as impossible to answer as whether a blush is physical or mental – or, for that matter, whether a person is. Everyone is both, inseparable even by a surgeon’s blade.
My third answer for becoming a positive deviant: Count something. Regardless of what one ultimately does in medicine – or outside medicine, for that matter – one should be a scientist in the world... If you count something you find interesting, you will learn something interesting.
People with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars.
Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive.
But even more daunting is the second kind of courage – the courage to act on the truth we find.
When someone has come to you for your expertise and your expertise has failed, what do you have left? You have only your character to fall back upon – and sometimes it’s only your pride that comes through.
Hope is not a plan, but hope is our plan.