She joined our organization a year ago, she mentioned that her husband was going through cancer treatments but he's had it before and they did treatment which took care of it. She sounded confident that they would go through this again and it would be fine. No big deal. I thought to myself treatment for recurrent cancer which has spread, yikes, can you really be so sure? But I made no comment. Why would I do that?
During the course of the year, it seemed to prove more difficult. More appointments, more procedures, more bad episodes. They were doing the best they could!
At the meeting yesterday, somebody asked her about her husband. She said that the treatment had not worked and 'they gave him less than a year.' More yikes. She said they were going to Hawaii next month, good idea. But she said "But it turned out the treatment only had 30% chance of working and they never told us that!" Was there some anger or bargaining or blaming? Did she mean that if they had 'known,' they would have tried another treatment with a higher track record? I didn't ask. Did treatments for recurrent cancer have high levels of success? Was the patient 'told' and they didn't hear it? Or didn't want to hear it? Who would? Patients hearing bad news would like something to blame. It should not be happening to them! Or any of us!
Do we think that if we do conventional medical cancer treatment, that the disease will be cured? That the curve would be low and flat and then rise steeply at the end. Meaning that nearly all of the people who received the treatment would have good results or be cured or have a high number of years of survival or however success is measured?
This post isn't really about this couple, it's about Atul Gawande's book "Being Mortal." He is a big believer in bell curves (see above). That with serious illness the response to treatment is some form of bell curve. Many people would have some kind of response and a few people would have very good results and some would have unfavorable results.
His point was that we all want to be at the far end of the curve. The fortunate ones beyond the third standard deviation (the numbers under the curve.) That we will be the one with the best outcomes, we will be cured with a long life in front of us. But the numbers are not with us. We will likely be at the near end of the curve. He writes a lot about doing that planning for that near end of the curve. If we let go of the far end of the curve, many other options open up for us. Some might look at it as 'giving up hope' or 'giving in' or ''not striving for the best.' But are we doing ourselves any favors here? Gawande talks about his father's progressive paralytic illness. Rather than looking for a cure (he knew there wasn't one,) he worked with his father about what was important to him right now. His father mentioned that he would be ok if he could still eat ice cream and watch football. They designed the treatment plan around that. It wasn't so that he could return to playing tennis (the far end of the curve.)
We can never judge others facing serious illness or end of life issues. We can only hope that when that time comes for us, we can do it with grace. I do know that you cannot skip any of the steps.
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