Generous Orthodoxy  

Friday, August 24, 2007

Thinking ahead about dying

A striking op-ed article in today's New York Times, "The Bad News First," by Nicholas A. Christakis, M.D. of the Harvard faculty, makes the startling point that doctors typically do not give patients accurate prognoses and make their last weeks miserable by giving them unnecessary treatments. Here is an excerpt:

Doctors who wrongly think that patients are going to live much longer wind up recommending needlessly painful and expensive treatments. This phenomenon is neatly captured by a gallows-humor joke told by hospice nurses: Why are coffins nailed shut? To keep doctors from administering more chemotherapy.

By not making or communicating prognoses, doctors can make the end of life more unpleasant. Patients are given no chance to draft wills, see distant loved ones, make peace with estranged relatives or even discuss with their families their wishes about how to live the end of their lives. And they are denied the chance to make decisions about what kind of medical care they want to receive.

Roughly half of Americans die with inadequately treated pain. Large minorities suffer symptoms like shortness of breath, nausea or depression. Four in five die in hospitals and nursing homes, rather than at home as most prefer. And more than half significantly burden family caregivers in the course of their final illness: the family loses its life savings, a caregiver has to quit work or a spouse falls seriously ill.

For reliable prognoses to become a routine part of medical care they must become a priority of medical research and education. Less than 5 percent of research focuses on prognosis. Textbook descriptions of diseases cover prognosis less than 25 percent of the time. And medical schools and residency programs almost completely neglect training in prognostication.

Greater investments in new statistical tools and databases that help physicians predict outcomes are also needed. With these, doctors could translate the clinical, biochemical and genetic information they collect on their patients into statistical predictions of life expectancy that could supplement their own clinical judgment.

Doctors often say they worry that predictions about survival may become self-fulfilling prophecies or cause patients to lose hope. But a realistic assessment of how long a patient has to live need not cause either the patient or doctor to become pessimistic. It should only refocus attention on the quality of the patient’s life. Sometimes living life to its fullest requires knowledge of its finitude.

Saturday, August 18, 2007

An image of a godly father figure

From the NY Times sports section, August 2, 2007 (article by George Vecsey):
Son. That's what Bill Robinson called Darryl Strawberry. Not Darryl or Straw or any street variations. Son. On days when Darryl wasn't quite ready to play, Bill would materialize in front of Darryl's locker, using that deep, melodious voice.

''When I dogged it,'' Strawberry was saying the other day, in grief, ''Bill would get all over my butt, but he never yelled. He said, 'You're the best in this business.' He always called me 'son,' like he was my father.''

The Mets called him Uncle Bill, and he was a brother to many other people, including me. He earned four World Series rings with four different teams and, who knows, he might have earned another one as the Dodgers' minor league instructor, but he died in his hotel room Sunday at age 64, and a lot of us are in pain.

''Bill was an incredibly patriarchal person,'' said Ron Darling, who pitched for the Mets when Robinson was the hitting instructor in 1986, and is now an insightful commentator. ''Bill tried to pass it on to Darryl,'' Darling added. ''He'd put his arm around him. Darryl wasn't ready, and Darryl knows it.''

Darryl was the prodigal son that everybody expected to die young. But he has beaten back stomach cancer and intemperance and legal issues to run an autism foundation, based in St. Louis. Now, Strawberry is in New York, waiting to attend Robinson's funeral Saturday at the Gloucester County Community Church in Sewell, N.J., glad that his surrogate father got to see him sober and healthy.

''He loved me so much,'' Darryl said. It was an unconditional love, far beyond the immense talent Strawberry alternately brandished and squandered.

...Bill [shared] his love for his strong and beautiful wife, Mary, and their two children, Bill and Kelley Ann. We became friends, in ways I don't think writers and players do these days, what with the huge gap in income, and the new edge between athletes and the news media.

...After three years of failure, Robinson wound up in Syracuse, but he fought his way back, first with the Phillies, then with the Pirates, earning his first ring as an important member of that boisterous we are fam-a-lee team of 1979. He remained the same person -- straight, religious, mindful.

Bill invited my 11-year-old son into the Pirates' clubhouse after a spring exhibition game in 1981. Suddenly a naked Dave Parker and Bill Madlock emerged from the shower, wearing jewelry and nothing else, and talking the normal, hilarious, scatological trash. In that deep voice, Bill told my son, ''Uh, David, maybe you'd better wait outside.''

....After batting .258 in 1,472 games, Robinson was hired by the Mets in 1985...''Bill would get on you, but he wouldn't raise his voice,'' Mookie Wilson, who didn't need much prodding, said. ''Bill was more subtle than that.''

''He was able to have a close family in a business that does not encourage it,'' Darling said, adding, ''He did not allow you to go on the field without your full uniform. He'd make you tuck in your shirt.''

....The Mets won the 1986 World Series -- Bill's second ring -- and then underachieved, which led Frank Cashen, the general manager, to dismiss Bill and Sam Perlozzo as a crude warning to Manager Davey Johnson. Robinson could have handled the Mets better than a few lummoxes who came later, but a managing job never happened.

He earned a third ring as a minor league instructor with the Yankees, and a fourth ring in 2003 as the hitting instructor with the improbable Florida Marlins. I got to hug him and Mary outside the clubhouse during that Series. I'd like to say to the fans, the next time you're tempted to complain about all the rich bums in baseball, think about my friend, who called Darryl Strawberry son.