But he's distressed by her refusing effective analgesia and suffering unnecessarily. I also thought he was more involved in some of his patients' lives than they wanted him to be. I have no doubt that it will take me a while to fully absorb what I've read. And although his striving won him a few more hours of life, he lost forever the chance to spend time with his family and to say goodbye to his fiancée. In the concluding chapter Casarett shares his list of essential questions, a shortcut to wisdom distilled from the preceding pages.
Still others are more nuanced and defy snap judgments. Why do some leave a legacy, while others prefer to celebrate and enjoy their time with family and friends? Or a few weeks or months? Or a few weeks or months? Finally, though, despite many misunderstandings, we seemed to be making progress across a river of circular arguments and recriminations. What if a loved one were in this situation -- how could you help that person decide how to spend the time that remained? But for the most part, he waited to die. And he does so in a practical way for clinicians who are not palliative care specialists. These patients of mine reconnected with friends and family, for instance chapter 3 , or made amends chapter 4 or left a legacy chapter 7 , or helped others chapter 8.
What if a loved one were in this situation -- how could you help that person decide how to spend the time that remained? He also was very wordy about coming to his conclusions, and the conclusions I thought were usually self-evident anyway. At the same time, these stories reveal that some choices may be harmful to the dying person or those closest to him. The answers are sometimes heartening, sometimes dismaying, and often both. Some examples are less grand but no less admirable chapters 6 and 10. Every member of her health care team—from the medical student to the senior attending—categorically denies any link between her past actions and current crisis.
Why do some fight and struggle to the last minute, while others accept their fate and use their limited time to reconnect or reconcile? But perhaps she paused for a moment, and the path leading onward disappeared. His goal—his only goal, as near as I could tell—was to cling to life as long as possible. Maybe there is an overarching organizational structure—a taxonomy—of the last acts that people pursue near the end of life. How best to spend the days or weeks they have in front of them? And that is anxiety-provoking for any physician, and particularly for one who was as young as I was then. More interesting to me were the ones who wanted to be sure to tie up loose ends at work, with their families, with projects. I thought he also relied too much on art and literative to make his points, although I don't really feel that he was trying to impress with his knowledge.
Do we become more altruistic? He is certain, too, that doing so is essential to survival. The tremendous diversity of these last acts makes clear that there is no formula for dying well or choices that are right for everyone. And it was then that she would have realized that this bench could be her stage, if she wanted it to be. These represent categories of last acts that Sylvester might have considered for himself. Psychology, ethics, anthropology, neuropsychology, and even economics, I decided, would all have a contribution to make.
He lived for about five weeks after our conversation that night in his hospital room, and in that time he made a few choices. Instead of rejecting her explanatory model, they use it to reframe her pain and thus free Marta to die as comfortable as possible, both physically and spiritually. Others faced with the same diagnosis would have concentrated their attention, perhaps, on their illness and impending death. At the same time, these stories reveal that some choices may be harmful to the dying person or those closest to him. Casarett's fluid writing sets the stage with provocative patient stories and historical accounts of iconic last acts, such as the notes left by coal miners who perished in the 2002 Sago explosion. David Casarett, a palliative care physician and researcher, specializes in the care of patients near the end of life. The few visitors who do notice it mistakenly assume that it is my own work.
From history, for instance, and from biographies. But how many of us will take the measure of our remaining time with the same ponderous scrutiny? From the palliative-care perspective, your recommendations affect—if not determine—whether patients continue chasing survival at any cost instead of embracing what time is left. As someone with aging parents and other loved ones, someone who has lost a spouse to cancer, and as someone with a chronic and life-threatening disease myself, I have much here to ponder. Casarett's insights on this and a variety of common dilemmas of patient care prompted me to rethink some of the advice I've been sharing over the years. Nor, I suspect, would most of us.
A chaplain experienced in such scenarios intervenes, advising the health care team to respect and support Marta's beliefs. More interesting to me were the ones who wanted to be sure to tie up loose ends at work, with their f It was interesting to read about all these different people and how they chose to spend their last weeks, days, hours. The tremendous diversity of these last acts makes clear that there is no formula for dying well or choices that are right for everyone. I imagine, for instance, what Sylvester might have learned from three men who shared a single land line on the ninety-second floor of one of the World Trade Center towers in the Carr Futures conference room, placing calls to friends and families about ten minutes before the tower collapsed. It seems to be hiding, unwilling to compete with its bright, oversized neighbors.