A Time to be Born and a Time to Die

Abstract

“I wanted a perfect ending. Now I’ve learned, the hard way, that some poems don’t rhyme, and some stories don’t have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next. Delicious ambiguity.” — —Gilda Radner US actress and comedienne (1946–1989) What would you do if you knew you had 6 months to live? How would you choose to spend your time? Would you be willing to try an experimental and risky therapy that might decrease your quality but increase your quantity of life? What would you do if you knew that your patient had 6 months to live despite current clinical stability? Would you tell him? Would you be more or less “aggressive” with treatment options? Article p 392 Physicians are often faced with life-or-death situations. In the abstract, we can conceptualize and rationalize biology, but the ability to convert our understanding of the natural course of a disease to a useful, sensitive, and realistic conversation with a patient and his or her family is something with which few are comfortable. This is especially true when the patient is awake, alert, and ambulatory. The word “prognosis” is derived from Greek, defined as “a forecast of the probable course or outcome of a disease.”1 Clinicians recognize that in most chronic illnesses, the prognosis is, at best, a guess but that ultimately death is inevitable. However, it is the time course, manner of death, and quality of life along the way that our patients most want to know. Physicians fear that delivering the news of a grave prognosis will send the patient into despair and rob them of any hope. Many clinicians still see death as professional failure and therefore …