Dr Atul Gawande on Aging Dying and Being Mortal FRONTLINE

One of the reasons I write is it gives me my chance to dive into problems that I'm very confused about. I've written about, you know, what are we supposed to do about the cost of health care? Why is the malpractice system so crazy and what's the way it should be? I've written about why do we itch? You know, if it's confusing and interesting to me, writing is my way of diving in and figuring out what to at least think about it. And this was one of the big ones. The two big unfixables are aging and dying. You know, they're not, you can't fix those. We're afraid of talking to the patient about these problems as well. A lot of doctors feel like, I know how to have this conversation. I know exactly what I'm doing. But what I knew, what I could see over and over again was that we weren't particularly good at handling people going through the last phase of their life. I've had to learn that because of patients with whom, you know, they did not end up with a good experience at all. And then I've had to learn it the hard way because of my dad. Do you remember when dad first started to get pain in his neck? He thought either playing too much tennis or just muscle. And instead what they found was a tumor, a huge tumor. I remember I took notes in my journal around that time, and my dad saying, the way things are going, I could be bedridden in a few months. The tumor had extended into his midbrain. The suggestion was that we should go see what options there might be for chemotherapy. So the oncologist lays out eight or nine different options, and we're swimming in all of it. And my dad says, well, what if I don't take any? And she said, well, that's your choice. Then started talking about how, you know, you really should think about taking the chemotherapy. Who knows, you could be playing tennis by the end of the summer. I mean, that was crazy. It made me very mad because it was, I mean, you know, the sky's potentially within weeks of being paralyzed. It was holding out a hope that was not a realistic hope in order to get him to take the chemotherapy. When he made the final decision that he doesn't, you know, want to, I told him, for me it's okay if you're paralyzed, so what? I can take care of you. And that's the main difference, it was not fine for him. The oncologist was being totally human, and the oncologist was talking to my dad the way that I have been talking to my patients for 10 years. But hope is not a plan, and in fact, we find from our trials that we are literally inflicting therapies on people that shorten their lives and increase their suffering out of an inability to come to good decisions.