Sunday, July 5, 2009


I was at the gym yesterday, on the 4th of July. Independence Day. While on the elliptical, the TV had ESPN on, and being that it was 70 years ago that day that Lou Gehrig made his famous farewell speech, they were showing some of the details of his life's story. I don't typically watch ESPN, but thought it was worth a look, given that the disease that carries this man's name is one of the more common that I see in hospice patients. Now, I haven't done any research on what was said, but it struck a chord with me. Lou was apparently diagnosed at Mayo Clinic. Not much was known about the disease at that time (though I'm not sure a lot has changed in 70 years...more on that later). The show went on to talk about how, after his retirement from the game he loved, the man sincerely believed that he would get well. His wife and his doctor from Mayo carried on a correspondence in which they conspired to keep the truth from him so as to "not take away his only hope". Lou also wrote to the doctor, describing people he had met who "got better", yet the doctor did not even tell the man that those he was describing had a different condition. It wasn't until very late in his disease that his letters reflected a knowledge of the inevitable truth. He faced that truth with character and strength, and I deeply wonder what would have been different for this man had his family and his doctor been truthful.

Fast forward 70 years. I had a call from a patient later that day. She has a complicated illness about which I will spare you the details. She is very much ready to die, but her family is most definitely NOT ready to let her go. There is, thankfully, in this case, no "conspiracy of silence" as I see in some families with differences of opinions, and as was seen in Lou Gehrig's case, but there is clearly a conflict of feelings. I am certain these feelings have very deep roots, who knows on what basis. Anyway, the patient wanted to stay home and let nature take its course, yet the family wanted to take her to the hospital for treatment "in case there was something that could be done". The patient, though it was not what she might have otherwise chosen, wanted to make sure her family's wishes were followed, and agreed to go in to be checked out. Her family's feelings were more important to her than her own wishes.

I don't think a lot has changed in 70 years. We still can't cure ALS, Lou Gehrig's disease. Patients may live a bit longer now with better general medical care, and hopefully their death is more comfortable now with good palliative and hospice care. Families and doctors still don't want to take away hope, though thankfully now some are realizing that hope is so much more than hope for a cure, and that honesty, while difficult, is the best course in discussing prognosis.

July 4th. Independence Day. 70 years ago, a giant of a man bravely faced an illness he didn't understand. Yesterday, a giant of a lady faced an illness she didn't understand. Both placed the needs of others ahead of their own. Both will ultimately share the same fate, as will we all. I pray that we honor those who have given their lives for the freedom of this country, and those who have dedicated their lives to others, and all those who have faced or are facing the final chapters of their lives.

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