Do you want chemo and three months of life, or six weeks of life without the nausea and vomiting that the chemo causes? Do you want high-risk open-heart surgery, with a fifteen-per-cent risk of dying during the operation, or would you rather continue as you are, with a fifty-per-cent chance you will be dead in two years? Do you want a prostatectomy, which has a five-per-cent chance of impotence and incontinence, or radiation, with a three-per-cent chance of leaving a hole in your rectum, or would you rather “watch and wait,” with the chance that your cancer will never grow at all?
That’s from Lisa Rosenbaum’s July 2013 piece in The New Yorker on shared decision making. Her most recent piece, which I also enjoyed, is this one on the relationship between extreme exercise and heart damage. It hits close to home because my wife will run her second 50k next month. Training alone includes several marathons over a few-week span. This, to me, is unfathomable.
Here’s another terrific piece by Lisa that taught me a great deal about stenting and helpful vs. unnecessary care. (This is saying a lot since I know quite a bit about this stuff already.)
It was in these gaps between data and life where I lost Sun Kim. There is no guideline that says, “This is how you manage an elderly man who asks nothing of anyone, who may or may not be taking his medications, and who has difficulty coming to see you because he vomits every time he gets on the bus.” In a world with infinite resources, we could conduct clinical trials to address every permutation of coronary disease and every circumstance. But that’s not the world we live in. And in our world, I reached a point where I could not keep Sun Kim out of the hospital.
The rest of Lisa’s pieces are here. I was not aware of her and her work until relatively recently or I’d probably have referenced it many times by now.