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Don’t let the medical industry own your death

When my grandmother was diagnosed with pancreatic cancer, we were all told to come visit immediately. By the time I got there, they had already given her a dose of chemotherapy. I was furious. Why do you give a dying 80 year old person a dose of chemotherapy? She never got out of bed again.

I could not understand why the doctors had given her the option of chemotherapy. She wasn’t expected to live more than a few weeks with or without it.

My family explained that this was my grandmother’s choice. She wanted the chemo. She wanted any chance she had to live longer. I was delighted she wanted to fight. And I selfishly wanted to be able to hang out with her during her final days.

What I didn’t understand at the time was that doctors have as hard a time as the rest of us talking about death. They probably have an even harder time “giving up” and accepting that there’s not really anything medicine can do to cure someone. Informative doctors want to give you all the choices and explaining the reality of your situation is hard. Maybe they did explain to my grandmother that the chemo wouldn’t prolong her life much, maybe they explained her quality of life would decrease and maybe she wan’t able to hear them because she wasn’t ready to give up on any chance no matter how small.

Reading Atul Gawande’s Being Mortal gave me a lot more insight and understanding into both our society’s way of handling death. He said we’ve given our end of life process to medicine. And doctors are not trained to understand what a patient most wants (like the ability to continue to eat chocolate or talk to your grandkids) but rather to either try to extend their life or to give them all the medical options without helping them weigh what those options mean within their choices. We are letting the medical field decide how we will live our last days. They may be able to help, but they are not in the business of figuring out how you want to live and then facilitating that. Instead they tell you what medical options you have and try to do the most they can to prolong your life even at the expense of comfort or quality of life. And there’s rarely a time when doctors can’t do something more. They can insert feeding tubes, try experimental drugs, remove parts of tumors, but those things might not always help you live the life you want.

Atul Gawande’s message really resonated with me when — while reading his book! — I called an ambulance for someone who didn’t want one. They clearly said they did not want an ambulance and did not want to go to the emergency room. I could not in good conscious not call an ambulance. They weren’t in a position to stop me from calling one, so I called for one but it weighed on me. I was reading a book about how we should be able to choose the medical care we want and I clearly went against someone’s wishes. Atul Gawande says this is a natural conflict, “We want autonomy for ourselves and safety for those we love.” (In my defense, I did not think they were capable in that moment to evaluate whether they needed an ambulance or not. One of my friends suggested just waiting until the person passes out and then its complied consent. I figured that was even worse. Looking forward, if someone you know is likely to be in that position, ask them their wishes ahead of time. Unfortunately, we don’t usually have that option until someone is clearly ill.)

“We want autonomy for ourselves and safety for those we love.” — Atul Gawande

He recommended this set of questions for helping people decide on treatment options:

What is your understanding of the situation and its potential outcomes?
What are your fears and what are your hopes?
What are the trade-offs you are willing to make and not willing to make?
And what is the course of action that best serves this understanding?

An example of a trade-off might be, are you willing to risk being in a wheel chair in order to get rid of some of the pain? Are you willing to lose your sense of taste to see if this chemotherapy will work?

In particular, I thought his trick of asking “what’s the longest anyone has lived with this treatment” instead of “how long do you expect me to live” was a very good one. He said “Sixty-three percent of doctors overestimated their patient’s survival time. Just 17 percent underestimated it. The average estimate was 530 percent too high. And the better the doctors knew their patients, the more likely they were to err.”

Throughout the book, Atul Gawande used very personal examples of family members and friends who were faced with difficult end of life decisions. He described cases where he thought he could have done better and cases where he helped people make the right decisions. The best, most difficult ones seemed to be the ones that didn’t pursue every chance medicine could offer.

As for my grandmother, we brought her home and worked with hospice. She died in her own bedroom surrounded by all her children and grandchildren. While I’m sure she was not ready to go, I’m sure that’s how she would have chosen to go.

I recommend reading Atul Gawande’s Being Mortal.

Originally published on Medium.

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How much big is better?

I think I know what a small house is. One year my family of 4 lived in a one room house without plumbing. And some of the neighbors lived in smaller houses. We moved every year and sometimes we lived in spacious houses, other times in small apartments. But we always had enough room. (Although as teenagers, my sister and I might have wished for another wall between us sometimes.)

I was informed last week – 10 times no less – that I live in a small house. We have 1300 square feet upstairs and 1300 square feet in our finished basement. It is not a small house. It’s a big house. Yet the person looking at it kept saying it was such a small, cute house.

She was a designer. I concluded that most people in our area must value big. And bigger. In 1950 the average American home was less than 1,000 feet. In 2006 the average house was about the size of our house, 2300 square feet. The dream house must be bigger than that now. When given the choice between remodeling to fit changing needs or just buying a bigger house, most Americans must pick the bigger house. Since we live in a huge house (by my standards), I figured most of her clients must live in enormous houses.

I spend most of my evenings sitting on the hardwood floors in the kitchen playing with the kids and talking to Frank while he cooks. I want a comfier kitchen/dining room, not a bigger house. I want to continue to hang out close to Frank and the kids, not have a more comfortable place elsewhere. (I’ve got that too.) I have not figured out how a bigger house would add to our quality of life at all. (Luckily the designer seems to understand we want a cozy, warm space for us and friends to hang out.)

What flabbergasts me is the new definition of what a “small house” is. I have nothing against big houses. Or enormous houses. I just resent being told my big house is small. But I guess it’s all relative.

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You don’t know what makes you happy

Dan Gilbert, a Harvard psychologist, says that we are terrible at predicting what makes us happy.  In Stumbling on Happiness he explains how we are terrible at predicting what will make our future selves happy.  For example, we think we want to be skinny and then we are surprised when the future self isn’t happy even though they are skinny.  There’s a good brief summary of the book in the Washington Post article, C’mon, Get Happy? It’s Easier Said Than Done.  If you enjoy the article, I recommend the whole book, Stumbling on Happiness.

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You don’t want money. Really.

You don’t want money.  You want the things money can bring.  Most likely you want happiness or joy.  You want money so that you can do more of the things that bring you happiness or joy.

What would the world look like if we concentrated on what brought us joy instead of what brought us money?

And you don’t really need money to do what brings you joy.  If I wanted to go spend a month or a year sailing around the Caribbean , I could make that happen.  (Um, once I convinced Frank that is.)  If I wanted to be a professional student, I could do that too.  (Wait, I already am a lifelong student.)

Pursue what brings you joy, not what brings you money.  So if you don’t want money, what do you really want?

Thanks to Steve Pavlina’s podcast for expressing this idea this way.

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Are you happy at work?

According to the Chiumento Happiness at Work Index the top ten things that make us happy at work are (in order):

  • Friendly, supportive colleagues
  • Enjoyable work
  • Good boss or line manager
  • Good work/life balance
  • Varied work
  • Belief that we’re doing something worthwhile
  • Feeling that what we do makes a difference
  • Being part of a successful team
  • Recognition for our achievements
  • Competitive salary

I’ve heard that having a best friend at work is the best way to make sure you are happy at work!

Interestingly enough, the things that make us unhappy are not quite the opposite of that:

  • Lack of communication from the top
  • Uncompetitive salary
  • No recognition for achievements
  • Poor boss/line manager
  • Little personal development
  • Ideas being ignored
  • Lack of opportunity for good performers
  • Lack of benefits Work not enjoyable
  • Not feeling that what I do makes a difference

So, for example, making a good salary won’t necessarily make you happy but making a bad salary is likely to make you unhappy.  So a good salary is necessary in order to be happy but it doesn’t make you happy in and of itself.

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Five Easy Ways to (Maybe) Discover What You Are Meant to Do With Your Life

Pamela from Escape from Cubicle Nation has these five questions she recommends answering to find out what you should do with your life.  I answered them for fun and then I debated posting them here as they could be a bit personal but I thought it would be fun to see if you guys can figure out what I’m passionate about by reading them.  Your ideas are welcome!

What is your favorite movie?  Pelican Brief – she solves a mystery, writes a brief, it gets noticed by important people, she’s in New Orleans – my second favorite city, trying to hide – I like the challenge of how you would hide, trying to right a wrong.   My next favorite would be an action movie – any of the Tom Clancy movies with Harrison Ford, or that one where Harrison Ford proves he’s innocent of murdering his wife because a one man arm did it or the Saint or that one where they track nuclear weapons to New York City.  Action all the way.  With a challenging mystery that the main character solves.

What are your favorite channels on television?  Channels?  Frank tapes all the shows with the DVR.  All I know are the names of my favorite shows – not even what day they come on!  ER and Gray’s Anatomy would be my favorites although they tend to get a bit soap opera-ish.  I also enjoy watching CSI with Frank.  If there’s anything else on … well, I’ll never know if I like it unless Frank tapes it and says I should watch it.

What kind of art museums are you attracted to?  Art.  Hmm.  I liked seeing all the dinosaurs at the Smithsonian.  Does that count as art?  If I had to pick an art form, it would be photography.  There’s a photographer here in Colorado who has studios at the airport and in Broomfield and he takes amazing pictures of wildlife.  But I like pictures of people best.  They don’t have to be people I know but those are the best ones.

What kind of music do you love? Country music.  Time Marches On and Any Man of Mine and the one about the girl (as the boy grows up) are probably my favorites.

What kind of outdoor environment makes you the most happy?  Summer.  Sitting outside at a restaurant in downtown Fort Collins.  Preferably with friends but alone is still fun as long as there’s lots of people around and lots going on.  Sitting on the Ramblas in Barcelona rates pretty high too.  As does the River Walk in New Orleans.  And parts of New York City and San Francisco.  Busy, hot cities in the summer.

So what do you think?  Do you know what I should do now?

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Which would you prefer, more money or more friends?

I just read a very thought provoking article, Why Having More No Longer Makes Us Happy by Bill McKibben.  The author argues that pursuing more wealth worked well in the past when we didn’t have much material wealth but now that we are a relatively wealthy nation, pursuing more and more wealth is making us less happy not happier.   His main points are:

  1. We are pursuing more and more wealth because it worked in the past,
  2. We are spending less and less time with family and friends,
  3. We are busier and more isolated,
  4. And it isn’t working anymore.

He points out that if you are rich in relationships and poor, more money might make you happy, but if you are poor in relationships and have plenty of money, a new friend will make you much happier than more money.  If you are a peasant in China with lots of relationships and no money, a little money can go a long way towards making you happier but a sixth person living in your house won’t.  On the flip side, if you are an American living in a 2000 square foot house, another friend might make you a lot happier than the money for another coffee maker.

He argues that in the pursuit of wealth, we’ve lost our community.  We spend less and less time with family and friends and more and more time isolated: commuting, working, watching tv, surfing the internet.  And yet studies show that it’s social networks (the real ones, not the virtual ones) that keep us happy and even healthy.  Robert E. Lane, a Yale political
science professor writes that "evidence shows that companionship … contributes more to
well-being than does income."

One point he made that really struck me because I can’t tell you how many people told me that college was going to be the best years of my life and I kept asking, "Why?  Does it go downhill from there?"  Apparently it does if you look at the quality of your relationships.

Why do people so often look back on their college days as the best
years of their lives? Because their classes were so fascinating? Or
because in college, we live more closely and intensely with a community
than most of us ever do before or after?

Something I read recently said that the number of friends we have drops off dramatically after our 20s.  Recently, I’ve realized that I really miss the number of friends I had in my teens and 20s.  I did things with large groups of friends several times a week if not every day.  Now we are lucky if we squeeze something in once a week.  And even when you have time (like when I was on maternity leave), your friends likely won’t have time!

So think about it.  Increasing the time you spend with your friends and extended family will do more to make you happy than a raise at work.  And I’d even argue it’d make you happier than winning the lottery!

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You’ll have more patience if you are having fun

Gretchen from the Happiness Project had a great story today that emphasized the truth of her main point:

If you have plenty of fun in your life – if you make time to see
friends, to learn about things that interest you, to do the things you
enjoy, like reading or going to movies or hiking – you have a higher
store of patience and tolerance.

On the other hand, when you don’t have much fun in your life, it’s
easy to become preoccupied with the aggravations and frustrations.
There’s nothing to distract you from your bad feelings.

Gretchen was pushing a stroller through ice and snow and didn’t even realize how difficult it was until she got home because she was having so much fun talking to her friend.  It’s like a long wait at a restaurant isn’t noticeable if you are catching up with an old friend. 

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Winning the lottery isn’t all it’s cut out to be

Why do we all play the lottery when it’s been proven that winning the lottery won’t make us any happier?  Lottery winners are no happier six months after they win the lottery than they were before they one.  Many of them are considerably unhappier.

I wrote a few days ago about how money isn’t evil.  The flip side is also true – money won’t solve all your problems.   I think we play the lottery because we don’t want to go to work everyday and we think we want a new car, maybe a new house and fancier vacations.  The real problem is that we don’t know what we want – we don’t know what would make us happy.  While money is certainly an enabler and I believe having money is a good thing, it won’t help you figure out the purpose of your life.  Money won’t help you figure out what makes you happy.  It won’t tell you how to spend your day. 

The key to happiness isn’t winning the lottery, it’s figuring out what makes you happy.  I guarantee that if you know what makes you happy, what you enjoy doing every day, you can find a way to do that and pay the bills.   But no matter how big the jackpot is, it won’t tell you what to do with the rest of your life.