In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. 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 realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. 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. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.
The other day as I was stepping out of Star Grocery on Claremont Avenue with some pork ribs under my arm, the Berkeley sky cloudless, a smell of jasmine in the air, a car driving by with its window rolled down, trailing a sweet ache of the Allman Brothers' "Melissa," it struck me that in order to have reached only the midpoint of my life I will need to live to be 92. That's pretty old. If you live to be ninety-two, you've done well for yourself. I'd like to be optimistic, and I try to take care of my health, but none of my grandparents even made it past 76, three killed by cancer, one by Parkinson's disease. If I live no longer than any of them did, I have at most thirty years left, which puts me around sixty percent of the way through my time.I am comfortable with the idea of mortality, or at least I always have been, up until now. I never felt the need to believe in heaven or an afterlife. It has been decades since I stopped believing-a belief that was never more than fitful and self-serving to begin with-in the possibility of reincarnation of the soul. I'm not totally certain where I stand on the whole "soul" question. Though I certainly feel as if I possess one, I'm inclined to disbelieve in its existence. I can live with that contradiction, as with the knowledge that my time is finite, and growing shorter by the day. It's just that lately, for the first time, that shortening has become perceptible. I can feel each tiny skyward lurch of the balloon as another bag of sand goes over the side of my basket.