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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 days 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?
Instead, what they found was a tumor-- a huge tumor.
I remember I took notes in my journal around that time.
This is 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.
Temozolomide, vincristine, vinblastine.
And my dad says, "Well, what if I don't take any?"
And she said, "Well, that's your choice."
Then she 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."
And that was crazy.
It made me very mad because it was...
Completely not right, yeah.
This guy is 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.
The oncologist was being totally human,
and the oncologist was talking to my dad
the way that I had been talking to my patients for ten 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.