Why I Can’t Wait For A Terminal Diagnosis

 I Love Being Radical and I Also Abhor It

“Who? Lynn? She’s so left I think she’s sometimes left out.”  It was during the early years of my fifth decade when I first became aware that this was a more common than isolated perspective of me. It invariably evokes bunches of feelings, all good and fun.

When I hear ‘radical’ my mind sees the radical apex, the tap root of a tall, strong tree extending as deep and broad as its canopy. My mind also sees a parade of our greatest teachers who teach from a source of deeply held, radical beliefs, ala Mahatma Ghandi. But that’s only part of the story. If there was no congruent upward growth, the branches and leaves of the tree, the radicality would be unidirectional, un-balanced, and quite un-yielding. This I abhor, for myself.                       Tianzi Mt China

The Unyielding Mind

My appreciation for the martial arts is, in large part, related to the way we are taught to yield, to give way to an opposing force, to bend and, yet, be light, fluid, dynamic, being influenced by the environment.  This is where the balance comes in, the middle way, always adjusting. And how easy it is to become fixed, stubborn in our habits, opinions and beliefs. I’m grateful for not having heard myself being referred to as a ‘staunch’ what-ever.  This being said,

The Foundation For My Health / Illness Care Decisions: The Least Intervention Possible

On a daily basis I experience awe and wonder at our natural world.  Flora, fauna, geological formations and events, all amaze me. Our human-ness captivates me most of all. In my beginning studies of physics I was very influenced by the “4 Laws of Thermodynamics’. If these change, maybe I also will. Law #1 says that “energy can neither be created nor destroyed. It can only change form. Law #2 says that “Entropy is the measure of disorder & randomness (chaos) in a system.” If a system is not in equilibrium it will increase in [chaos] until equilibrium is achieved.  In the beginning there was the void and God hovered over it.

Then I began learning that life energy works counter to entropy, otherwise our bodies would just float around as particles. Now that would be a ‘mixer’, networking anyone? The life energy brings order to chaos. The nature of this life energy is, also, to achieve balance. The ‘official’ term for this Homeostasis = the state of dynamic equilibrium of the internal environment of the body that is maintained by the ever-changing processes of feedback and regulation in response to external and internal changes. (Taber’s Cyclopedic Medical Dictionary, 19th ed.)

This being said, I’ve come to realize, more than ever, why I can’t wait until I receive a terminal diagnosis before I have to make BIG decisions. Every decision I make now influences the course of future events. Therefore, my intention is to subject this body to as few medical interventions as possible, always weighing the risks vs. the benefits, the return on the investment. The same goes for weighing my choices about how much and what kinds of stuff I eat and drink and how I spend my time.

My Goal Is Homeostasis

I hope to watch my body as it progresses through its life cycle. Picture new human life forming. Energy is being transformed into growth. Aging and dying is, pretty much, the reverse. Unyielding doesn’t jive with Homeostasis – an ever-changing process. This informs my decisions about what medications and treatments I yield to because each interferes with, and/or stresses, un-intended collateral body processes.

But this is only my world view and it’s a dynamic one, maybe even radical.

The Life and Death Decisions                                                                        Terminal Dx - Shutterstock.com

You may already be taking a ‘maintenance’ medication or treatment. We do this to mitigate the effects of a health condition that will only / probably get worse without treatment. There are thousands of these: blood pressure meds, insulin, statins, dialysis, ventilation, on and on and on.  I do know people over the age of 65 whose bodies are still running on all vintage parts. They’re the ones who are helping to keep our health care costs down, and they are a minority.  The rest of us, well, we have a maintenance schedule to follow.

It’s easy to chuckle over the ‘adverse drug reactions’ that are reported at the ends of commercial drug advertisements, especially the Viagra ones. And if we happen to be taking one of these meds (OK, maybe Viagra s not a maint. med) we’re not going to have one of those serious side effects.  The first sentence of my Pharmacology Textbook:  ALL drugs have side effects.  One of the most common side-effects is either constipation or the opposite.  So now we have to add Colace, or the opposite to the maintenance schedule.  Some of us may be taking anti-coagulants, certainly if you have Atrial fibrillation or have had a heart valve replacement.  Now we’re at risk for easy bruising and GI bleeds.  Am I painting a Rocky Horror Picture Show?  Maybe yes, maybe no.

Palliative Care

Palliative Care treats symptoms of illness with no intention to cure or prolong life, usually initiated at the time of a terminal diagnosis.  It’s the italicized parts that get me thinking.  One difference between ‘maintenance’ care and ‘palliative’ care is that the intention of the former is to prolong life, and the latter is not.  Another difference is relative to the kinds of symptoms they treat.  Palliative care manages, primarily, symptoms of distressing physical, mental, or emotional nature: nausea, pain, accumulation of fluids and toxins in body cavities that cannot be naturally relieved, seizures, etc.. Maintenance care treats the underlying cause of the symptom – which is considered a chronic condition to be managed: one has high blood pressure caused by any number of different things, and treated by, a vast array of treatments; Parkinson’s disease – we treat the symptoms; diabetes, and on and on.

One Of These Days

In fact, it’s probably many days, each of us will be called on to make a choice about taking a medication or undergoing a treatment.  With absolute respect for everyone’s situation and choices, may I encourage you to ask yourself, each and every time, the following 4 Questions, given to us by one of my medical heroes, Atul Gawande:

  1. What is your understanding of your health condition?
  2. What are your goals if your health declines?
  3. What are your fears?
  4. What are the tradeoffs you’re willing to make and not willing to make.

The last question never fails to remind me of my Dad, back in the 70’s and about 10 years along his maintenance program for his heart that he always proclaimed was “about the size of a walnut”. I now know that his heart was probably quite large and flabby in its failure, but I will never forget his somewhat disgusted pronouncement that ‘nobody ever told him the damn pills would make him impotent’.

 

 

“Why I Hope to Die at 75”     – A terrific story that generated a surprising amount of controversy. Who knew?

Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either. Today, when the doctor recommends a test or treatment, especially one that will extend our lives, it becomes incumbent upon us to give a good reason why we don’t want it. The momentum of medicine and family means we will almost invariably get it.

My attitude flips this default on its head. I take guidance from what Sir William Osler wrote in his classic turn-of-the-century medical textbook, The Principles and Practice of Medicine: “Pneumonia may well be called the friend of the aged. Taken off by it in an acute, short, not often painful illness, the old man escapes those ‘cold gradations of decay’ so distressing to himself and to his friends.”

My Osler-inspired philosophy is this: At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless. And that good reason is not “It will prolong your life.” I will stop getting any regular preventive tests, screenings, or interventions. I will accept only palliative—not curative—treatments if I am suffering pain or other disability.

The author, Ezekiel J. Emanuel, goes on to enumerate regarding his approach to many things medical from colonoscopies,  preventive ‘screenings’,  pacemakers, to antibiotics, and it is fun to read. The article is a long one and, if you must, scroll down to the section quoted above. He also provides great stats throughout.