Sunday, April 4, 2010

Palliative Care For You, Serious Medicine For Me

Did you hear the one about the "palliative care" doctor who wanted more than palliative care for herself? She preached palliative care to others, but when she herself was confronted with a serious illness, she wanted nothing but the best care--no matter what the cost. It's not really a joke, of course, and it's not a funny story. But it is a revealing story.

It's the story of the late Dr. Desiree Pardi, who died of cancer last September, at the age of 41, as chronicled by Anemona Hartocollis, writing in Sunday's New York Times. Dr. Pardi was diagnosed with breast cancer a decade ago, and was saved by Serious Medicine. Whereupon she decided to specialize in "palliative care," described by Hartocollis as the "gentle gospel" of accepting mortality without engaging in heroic measures, all the while focusing on avoiding pain and getting one's affairs in order, in anticipation of death.

For decades, now, that's been a popular approach to sickness and death--at least for others.

And yet when the crunch comes, such palliative care seems not be popular with the palliators. They themselves are regarded, by themselves to be different, more deserving of care. But let the Times tell the story:

In 2008, while on vacation in Boston, she went to an emergency room with a fever. The next day, as the doctors began to understand the extent of her underlying cancer, “they asked me if I wanted palliative care to come and see me.”

She angrily refused. She had been telling other people to let go. But faced with that thought herself, at the age of 40, she wanted to fight on.

While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they were painful and offered only a 2 percent chance of survival. When the usual cycles of chemotherapy failed to slow the cancer, she found a doctor who would bombard her with more. She force-fed herself through a catheter and drank heavy milkshakes to keep up her weight.

So Dr. Pardi fought the good fight, for her own life, all the way to the end. It's a shame that she died so young, and a reminder that there are still victories to be won against cancer and other premature killers.

But we are also reminded that pretty much everybody thinks as Dr. Pardi did--we all want to live. Others, too, in the forefront of the "good death" movement have made similar choices, including Peter Singer, the Princeton University professor,who chose to finance long-term care for his mother, even as she declined from Alzheimer's. It's fine that Singer wants to help his mother, but he shouldn't then be able to deprive of us of the opportunity to help our mothers.

As for the cost of such Serious Medicine, as argued here at length, Serious Medicine that really works becomes Routine Medicine, and then it becomes cheap--indeed, Serious Medicine-turned-into-Routine Medicine is the beginning of a new health industry.

The point is, most of us want to fight for our lives, and for the lives of loved ones. And if we want to, we should all get that chance, to fight to the utmost.


  1. As a physician, I advocate vigorously for my patients. I have learned that these decisions are individualized and different patients have different beliefs, needs and wishes. However, it is a basic truth that most everyone will want everything regardless of effectiveness - as long as they do not have to pay. We already have the most expensive yet among the least effective medical care in the Western world. Do you believe that there is line we should not cross?

  2. Palliative care should be considered when the cancer has metastasized. But before that, ‘damn the torpedoes and kill that cancer.’
    Sounds like Dr. Pardi chickened out. Maybe she had a change of mind being 41.
    Me, I’ve seen my childrens’ children, and nobody should ask for more than that from God for himself or his mother!
    If I come down with Alzheimer's and don’t know who my kids are (& it does run in my family), then keep me on my blood thinners, pain killers and food. But if I come down with pneumonia or whatever else, no meds thank you, let the circle of life here on earth be closed.
    You said: “And if we want to, we should all get that chance, to fight to the utmost”
    I take exception. There are times when enough is enough, especially if you are a Senior like me.
    I hope others have prepared living wills outlining their wishes; so, their kids aren't tied in knots.
    A good thought provoking column Jim, thanks.

  3. I think palliative care is tremendously important for patients for whom there is no life-saving measure in existence. (Otherwise people should be free to choose to fight for their lives.) My dad had such palliative care, and those who administered it managed to make his last days as bearable as possible, and to afford him some dignity. He took comfort from the presence of the medical professionals administering that care.

  4. I was rather appalled that the palliative medicine doctor changed her attitude when sick; and one reason I'm appalled is that my family does NOT want extreme medicine -- and unlike the PM doctor, we mean it and have proven it by our actions.

    My sister said about the only satisfaction she got from my mother's death is that the people who always said "you wouldn't feel that way if it was YOUR mother" she could now say to them, well it was and both my mother and I DID feel that way.

    So yes maybe some people who say they don't want maximal medical interventions don't mean it -- but I mean it and my family means it and don't ASSUME that we want to fight for our lives at all costs.

    The well-known Dax Cowart who was treated against his will for serious burns is someone else who SERIOUSLY MEANT that he did not want to live at all costs.

    I certainly think the palliative care doctor has the right to change her mind, but that she did means to me that she was rather neurotic and ambivalent in the career she chose to start out with. Let people choose whether or not to live at all costs -- personally I only want to live at reasonable personal cost and suffering, then I prefer palliative care.