We all plan to live to 110, right? Dying in our own beds, after brief, painless illnesses? With smiles on our faces?
The not-so-pretty truth, "Frontline" reminds us, in an episode filmed at New York's Mount Sinai Medical Center, is that most Americans die in hospitals, some tethered to technology invented to help critically ill patients recover but that often merely places them on hold.
"We have a tremendous amount of technology to prolong life, but ultimately we can't overcome the patient's illness," says Mount Sinai's Dr. Scott Lorin. "Americans are now coming to ICUs to die."
It's a blunt message, hammered home by case after case of patients whose families face decisions regarding ventilators, continued treatments or other life-prolonging measures.
And it's hardly new, though until you've seen the system at work, you may not realize how quickly a simple decision can turn immensely complicated.
Plus, we all have stories - I have a doozy or two myself - about doctors who were wrong and loved ones who beat the odds, at least for a while, and lived to fight another day.
"People surprise us all the time," admits one doctor, who says she worries sometimes she might be "guiding someone to stop treatment when maybe that's premature."
But with health costs rising ever higher, you don't have to live in fear of so-called "death panels" to realize medicine's feeling some heat about keeping us alive when reasonable hope is gone.
"There's a tremendous pressure now to reduce care to numbers, as though there's an algorithm for every decision," notes Harvard medical professor Dr. Jerome Groopman. "When you look at, you know, Medicare expenditures at end of life and what is very glibly termed 'waste' - 30 percent of care is 'waste,' that's the new mantra - it's very hard to know what that means, and it's very hard to bring that out of Washington and into a hospital and at the bedside, with a single individual, facing death."
Groopman's argument - that for medicine to advance "requires pushing to the very edge" - might not hold appeal for all the people whose last months are spent fighting battles most of them will lose.
But it might for some, and as Dr. Keren Osman, of Mount Sinai's bone-marrow transplant unit notes, there's not even agreement among doctors about when enough is enough.
"Some physicians can continue giving treatment, and some find it unacceptable . . . The lines are blurred and they're different for different physicians," she says.
"You can have a lot of conversations [with patients] about these things, but I think when the moments come, I don't think that anybody can be completely prepared for what it's all about." *
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