Coincidentally, before resuming the second half of Atul Gawande's gut wrenching and enlightening essay in The New Yorker about end-of-life health care entitled "Letting Go, What should medicine do when it can't save your life?" yesterday, I stumbled upon Anderson Cooper's interview with Christopher Hitchens.
The latter, a giant of polemic and champion of atheism, discusses his battle with cancer.
I had the privilege to attend a talk he gave at the New York Public Library at the beginning of the summer, and back then Hitch was his usual vibrant and fiery self.
But yesterday, it was a bit of a shock seeing him sick for the first time.
The dramatic loss of hair experienced by cancer patients is always frightening.
Having said that, Hitchens still sounded strong and healthy, and his eloquence remains intact.
Later last night, after completing Gawande's New Yorker piece about end-of-life medicine, I couldn't help but admire Hitchens' attitude.
Gawande, a surgeon himself, explains how problematic medicine for the terminally ill has become.
The chief culprit is human irrationalism - both patients and doctors seem ill equipped to deal with death: the former remain in a state of unceasing denial and consequently subject themselves to needless and horribly painful chemotherapy, while the latter don't know how to tell patients that they are going to die.
This, argues Gawande, is largely a result of the unrealistic expectations modern medicine has created for us.
At one point, he delineates how the siblings of an incurably sick woman named Sara, "still held out hope for a cure.
The doctors simply weren't looking hard enough, they felt.
'I just couldn't believe there wasn't something,' Gary said.
" This reminds me of how many were shocked by science's impotence in confronting the BP oil leak, in spite of the obviously insurmountable hurdles.
It is also caused by our seemingly unconquerable fear of death, which often induces us to avoid considering such a fate altogether.
As Gawande explains, in the face of our imminent end, "our every impulse is to fight, to die with chemo in our veins or a tube in our throats or fresh sutures in our flesh.
The fact that we may be shortening or worsening the time we have left hardly seems to register.
" The author admirably admits his own inability to overcome the problem when he describes how even when he once made a deliberate attempt to be blunt about his cancer patients' perilous prospects, it was impossible to do so: "I said it had not been possible to remove all the disease.
But I found myself almost immediately minimizing what I'd said.
'We'll bring an oncologist,' I hastened to add.
'Chemotherapy can be very effective in these situations.
'" With this anecdote, Gawande is of course accomplishing much more than merely illustrating a capacity for humility.
What he's really doing here is forcing his reader to understand just how difficult and complicated the situation is-if even he, the author of an essay about the ills of human irrationality when confronting death, cannot himself tackle the challenge of expressing candor, one can only imagine how hard it must be for patients.
Because of these difficulties, we face a serious crisis, "a modern tragedy replayed millions of times over," as Gawande puts it.
In addition to the unnecessary suffering, it has also created an economic mess.
We all know that the health care system is dangerously expensive, but Gawande cites some chilling statistics: "twenty-five percent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little benefit.
" Still further: "our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery.
" It is clearly imperative, therefore, that our system change.
Doctors must learn how to talk to patients about the brutal truth, as David Newman also explains in his excellent book called Hippocrates' Shadow.
And patients must be made aware of the benefits of hospice treatment-which offers an astonishingly cost efficient and, according to a study, Zen-like life extending alternative.
Gawande curiously relegates to a parenthetical the elephant in the room "death panel" issue-how the radical right's vicious and cynical disinformation campaign thwarted Obama's attempt to incentivize doctors to take the initiative by covering the costs of having end-of-life conversations and then complaining about the exorbitant financial toll of Medicare, but, as is often the case, The New Yorker is above all that.
It instead prefers subtlety.
And the descriptions that permeate the article resonate far more powerfully than an explicit denunciation of Sarah Palin and co.
I say the article elevated my admiration of Hitchens' attitude in the face of cancer because it made clear how extraordinary a thinker the man is.
As a true intellectual must be, he remains honest and utterly sincere in his convictions.
His tone in the Cooper interview is consistent with his pre-cancer persona-always ironic, eloquent, careful, and tough.
He is quick to acknowledge that his heavy smoking and drinking likely caused his cancer, remarking that it would be "idle to deny it.
" Subsequently, Hitchens goes on to advise those watching to moderate substance abuse, prompting Cooper to characterize this as "probably the most subtle anti-smoking message I ever heard.
" This leads Hitchens to remark that such messages are typically "strident and therefore easy to ignore.
" Notice how even cancer does not alter his approach-as Cooper points out, Hitchens deals with his disease in an intellectual manner.
He could have summoned a menacing admonition, describing in lurid detail the agony of chemo.
But he chooses not to.
Rather, he coolly offers advice, bearing in mind that to do otherwise would be to succumb to the "strident" and therefore ineffective approach mustered by the anti-smoking campaigns.
Last, he takes his impending death like a philosopher.
He does not ask "why me," but instead recognizes that millions die every day.
Perhaps even more important is the fact that he does not delude himself.
Though it perhaps hurt me to hear him say it more than it hurt him, he explains that the statistics are strongly against him, very few live through esophageal cancer to tell about it.
As Gawande's article suggests, if people could become honest about looming death, they'd likely live out their final days in less miserable fashion, which would have the added benefit of saving countless wasted tax dollars.
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