How to Deal with Chronic Complainers

At every visit, your aging mother spends half an hour griping about the too-spicy food in her assisted-living community. Whenever you and a friend go clothes shopping together, she whines about how fat she looks in everything she tries on. A coworker constantly carps that none of your other coworkers puts in as much effort as she does.

Being surrounded by such habitual complainers can drain your energy and pollute your positivity, leaving you frustrated, irritated, disheartened and depressed. But there are ways to avoid getting sucked into gripers’ toxic traps. What helps...
Be sympathetic—but set limits. Complainers often feel unhappy, lonely, criticized or misunderstood. Resolve to listen to their grievances as compassionately as you can, but only up to a certain point. Set a time limit of, say, three minutes... or let your own internal cues (a feeling of being trapped, a knot in your stomach) tell you when you’ve heard enough. At that point, call a halt to the complaining by saying courteously yet firmly, “You have my sympathy. Now, let’s please talk about something more pleasant.” If the complainer still won’t quit, excuse yourself from the conversation, walk away or hang up the phone. Don’t chide yourself for cutting off the person’s rant—you are not being callous, you are simply protecting your own well-being.
Resist the urge to try to solve other people’s problems or fix their poor attitudes. If a person has a legitimate complaint and you are in a position to help—for instance, by speaking to the chef at your mom’s assisted-living facility—it would be kind of you to do so. But recognize that for many grouches, bellyaching is an ingrained habit or part of their personality. Since they usually are not looking for practical solutions (as is clear when they repeatedly ignore your suggestions) and are not open to an attitude adjustment, no amount of cajoling or cheerleading on your part will make the slightest difference. Accept the fact that it is neither your responsibility nor within your power to make everyone see a brighter side of life. Save your breath to save your sanity.
Tailor your strategy depending on your relationship to the ranter. In casual encounters (for instance, with whiny shopkeepers or grumbling taxi drivers), simply complete your business as expeditiously as possible while distracting yourself from their complaints by thinking your own thoughts. With a complaint-prone coworker, the goal is to avoid confrontations that could heighten conflict—so be polite but keep your distance, refusing to get sucked into a gripe-fest that could end up reflecting poorly on you. With a close friend or loved one, you’ll want to offer more compassion, of course. But if complaining is really out of hand, consistently shift the conversation to anything the person said that is pleasant... and then gently add that when people are suffering so much, they often can feel better if they consult a mental health professional.
Seek out positive-spirited companions. To help offset the stress of naysayers you cannot avoid, surround yourself with plenty of yeasayers—cheerful people who share and support your own glass-half-full outlook on life.
Consider whether you have a codependence on complainers. If you still seem to attract more than your share of bellyachers despite implementing the strategies above, ask yourself whether there’s an emotionally unhealthy underlying reason. Could you be using their faultfinding as a vicarious means of expressing discontent that you are too afraid to give voice to yourself? Do you secretly take satisfaction in the contrast between their constant grousing and your own image as Little Miss Sunshine? Do you feel the need to be a savior for others because it allows you to avoid facing your own sources of upset or pain? If the answer to any of these questions is yes, talk to a trusted friend or therapist about more appropriate ways to identify and deal with your own dissatisfaction.
Source: Judy Kuriansky, PhD, is a clinical psychologist and sex therapist on the adjunct faculty of Teachers College, Columbia University in New York City. She is the author of five books, including The Complete Idiot’s Guide to a Healthy Relationship (Alpha), and is a columnist and advisory board member for HealthyWoman from Bottom Line. www.DrJudy.com

Your Top 10 Clutter Questions, Answered

Post written by Leo Babauta.

Decluttering is a skill that you learn with practice, just like any skill. And just like other skills, there are many little questions and problems you need answered and solved as you get started.
Those of you taking the Clutterfat Challenge this month are facing these problems, and I’m here to help.
This post is a quickstart guide to decluttering — the most common questions answered. Also see last week’s Clutterfat Challenge post: How to Tackle Your Clutter.
1. Where do I start?
Start anywhere — really, where you start doesn’t matter, as long as you start. You’re going to get to all of it eventually, so pick a random spot to clear, and slowly expand from that spot. Start with a baby step — just one little space. Take just 5 minutes to clear a spot on a counter, and keep it clear. Clear a little more space later today. Tomorrow, clear a little more. It’s not difficult if you do it in small steps. Here are 18 5-minute decluttering tips to start conquering your mess.
2. How do I deal with the piles of mail and magazines? How do I handle paper cluttter?
Make a big pile of your mail and magazines. Now work through the pile very quickly. Take the top piece, and decide: can you toss it? If so, toss it in a recycling bin. If you need it, decide if it should be filed (and file it in a folder right now), or if it needs action — in which case, take action on it if you can do it in a couple minutes. Have an action folder to file things in if they need more than a couple minutes. Toss the magazines — you don’t need them. Work quickly through everything until you finished the pile. When you have more time, make another pile of paper clutter and work through it. Read more: 6 Simple Steps to Make Mail & Paperwork Painless.
3. What do I do if my family is the clutter problem?
Start with yourself. Lead by example. Declutter your personal space, and show how great it is. Start a positive discussion with them about why you’re decluttering, and ask if they want to join you. It’s a long process, educating people, but don’t ever force them or they’ll resist or be resentful. Read more.
4. I tend to keep things just in case I might need them again.
Make a list of your “just in case” stuff — or better yet, put them in a box — and see how often you actually need them in the next 6 months. If you didn’t need them, you can safely get rid of them. If you did, keep them. Read more: the just in case syndrome.
5. How do I deal with things that have a sentimental value, that bring back memories/feelings about a time you might not think about without a reminder.
Realize that your feelings, your love, your memories, are not in those objects. They are merely placeholders. You can easily keep those placeholders on your computer, or online. Some ideas:

• Create a digital photo album of your sentimental items.
• Keep pictures of your loved ones as your desktop picture or screensaver.
• Play photos in a slideshow for visitors, or for yourself.
• Create a digital scrapbook.
• Start a blog or a tumblelog with photos, notes, posts about the things you treasure most.

Read more: Letting Go of Sentimental Items and Getting unstuck from sentimental stuff.
6. I want to clean my clutter but sometimes I’m just too lazy to deal with it.
This is why we’ve created the Clutterfat Challenge — it’s motivation to finally get off your butt! But you can create other challenges: announce to your friends and family on Facebook and Twitter that you’re going to declutter for 10 minutes a day for a month. Or blog about your decluttering journey. Do it with others and make it fun. Make it a game with your family.
7. My biggest issue is getting rid of things that where given as a present by people I care about.
Free yourself of this guilt. Your loved ones gave you the gifts to make you happy, not to burden you for life, not to make you feel guilty. Allow yourself to be happy, and only keep things if they’re making you happy. Read more from Discardia and Miss Minimalist.
8. Where do I dispose of stuff?
I like giving things away to friends and family, charity, Craigslist and Freecycle. Read Miss Minimalist’s great list.
9. I don’t have time to keep things clean.
Create clean-as-you-go habits. These take seconds, and if you do them, you don’t need to do a lot of cleaning later. Read more: Develop clean house habits and 15 Clutter Busting Routines For Any Family.
10. Making time to declutter and follow through with disposal is tough.
It only takes 5-10 minutes a day — declutter one pile at a time, one flat surface at a time. Do it when you get home, and before you leave the house. Put things you’re going to donate into a box each day, and put that in your trunk. When you drive by a charity, drop it off. That takes 5 minutes.
Need more? Here are a few more articles:

• Keeping a stress-free, clean house
• 15 Great Decluttering Tips
• How to Declutter an Entire Room in One Go
• The Minimalist’s Guide to Fighting (and Beating) Clutter Entropy

Steve Jobs - Business Week, 1998

Lon J. Overacker Photography
#41171SV  El Capital Enshrouded
All content © Copyright 1993-2012 Lon J. Overacker 
www.lonoveracker.com

"That's been one of my mantras
---- focus and simplicity. 
Simple can be harder than complex;
you have to work hard to get your thinking clean to make it simple.  But it's worth it in the end because once you get there, you can move mountains."

Clearing Your Life for a New Year



Photography by Russ Shugart

Post written by Leo Babauta.

Every January, people rush out and get a gym membership, set a list of goals or resolutions, and get ready to take on a new year of frenetic activity.
Unfortunately, we don’t often clear space to make room for all this new stuff.
The beginning of the year is a great time for renewal of energy and taking on the things we’ve always wanted to tackle — clutter, fitness, work we’re passionate about, debt, and so on. But it’s also a great time to clear out your life, starting out the year on a blank page that’s ready to be filled.
While everyone’s life is different, I’ll share some of what I do to clear out my life.

• Review the year to think about what I learned, what mistakes I made, what I accomplished.
• Clear my schedule as much as possible. That often means saying no to people.
• Wrap up old projects, end commitments to people, so that my work plate is clearer than normal.
• Toss out old fitness and eating plans, to make room for new experiments.
• Clear my email inbox. If I haven’t answered the email recently, it’s probably not important, so I archive it. Act on or answer other emails, so that my inbox is emptied.
• Clear out other inboxes. That might be an inbox on a social network, or a list of things I wanted to do or read, or any kind of list really. File them away under someday, or delete or archive. Anything that’s taking some mental energy because I know I need to get to it, gets cleared.
• Clear my computer files. Usually this means deleting a bunch of files I don’t need, but I also just consolidate files into one folder or put them in an online archive (like in Dropbox).
• Clear paperwork. I rarely have any papers these days — I’ve slowly turned everything digital. But I still get things in the mail sometimes, so if I have any lying around, I dispose of them to clear out any remaining paperwork.
• Clear clutter. If there are areas that have become cluttered, I clear them out. Often it just means taking a box or bag of things that I’ve been meaning to donate to Goodwill.
• Clear my errands. I’ll make a list of all the errands I’ve been putting off, and do them in one afternoon.
• Clear my finances. I’ll take a few minutes to review my checking and savings accounts, Paypal, investments, etc. and make sure everything is in order. If there are little things that need taking care of, I do them so that my mind is cleared.
• Clear pantry and refrigerator of junk. Old crap that’s been lying around. Junk food if there’s any there (I don’t usually have any anymore, but I used to). Left with just good whole ingredients for healthy foods.

This might take a couple days, working off and on in little bits. For some, it might take longer. But when you’re done, it’s amazing. Your mind is clear and refreshed. You feel like you’re ready to take on anything.
To be honest, I do these things regularly throughout the year, and it’s great to keep a clean slate most of the time. But the new year is always a perfect opportunity to clear everything at once.

Who Needs Doctors, Anyway?

http://www.zocalopublicsquare.org/

Nexus

Who Needs Doctors, Anyway?

Getting Used to Life After Primary Care Physicians

by Ken Murray
If you think it’s hard to get an appointment with a family doctor now, just wait until you’re a little older. By 2025, it’d really be best if you avoided getting sick altogether. That’s when America will have a shortage of about 40,000 primary care physicians, according to the U.S. Department of Health and Human Services. Money is at the root of the problem (specialists earn a lot more than primary care doctors), and there is no cure in sight. Many of us won’t be able to get an appointment. At all.
So what’s a patient to do? You may not like the answer, but at least it’s simple: become your own doctor. I don’t mean you should go to medical school, of course. Nor do I mean you should panic-Google your itchy tongue (more on that later). But you do need to take on a new set of tasks.
Let’s look at the three things adult primary care doctors—also known as GPs (general practitioners), or general internists—do best. The first is to offer “episodic care,” meaning the sort of medical attention you get when you come down with something and head over to the doctor’s office. The second is to offer preventive care, helping you to head things off before they become a big problem. And the third is to monitor and treat continuing problems like diabetes or high blood pressure.
These are all essential services, and we’ll miss them when they’re gone. But here’s the best way to keep them—sort of—going.
First, when you get sick, use a walk-in clinic. These are usually called “urgent care centers,” and they’re often open 16 hours a day, perhaps located in a mall or pharmacy. So if your stomach is hurting like crazy, go consult your yellow pages or Google “urgent care” services in your city. In fact, do it before you eat that suspicious-looking soufflé and get too compromised to make good decisions. Check out the walk-in clinics nearby, write down the info, and put it on your refrigerator, so you have it ready. Here’s what you should not do: go to an emergency room with anything other than a true emergency, like a life-threatening problem. Misusing the ER is an incredible waste of time and money.
Second, start taking the lead in your own preventive care. The good news is that the resources are out there, and this wasn’t the case even as recently as five years ago. The best place to go is the website of the US Preventive Services Task Force. This is an entity that was created precisely to allow patients (and physicians) to have the most up-to-date and scientifically supported information on prevention. The recommendations come from non-governmental, non-biased experts, and there are strict rules in place intended to prevent personal biases—and especially monetary biases—from influencing the advice that’s offered.
If your research into preventive care reveals that you’re in need of some screening service, you can refer yourself directly to a facility that will take care of what you need. For example, go to a radiology center for a mammogram, go to a gastroenterologist for a colonoscopy, or go to a cardiologist for a treadmill. Then hit the urgent care center for blood tests, x-rays, immunizations, or other referrals. Keep a copy of all tests in your personal health record (for more information on this point, see my article on preventing medical miscommunications).
Third, if you’ve got chronic problems that require regular attention, start going to specialists for them. Studies show that primary care doctors do neither better nor worse than specialists when it comes to management of long-term problems such as diabetes, so it’s reasonable for you to seek long-term care with specialists, who will still be plentiful, rather than primary care doctors, who may be as rare as giant pandas.
In sum, being your own primary care provider, while not necessarily the most desirable burden to take on, can be a manageable task if you do a little planning and know where to go.
Now, a lot of these suggestions rely heavily on Internet use. That’s perfectly fine. But what’s not fine is frantically Googling your symptoms and coming up with half-cocked diagnoses. Before you know it, you’ll be suffering from smallpox, typhoid, and rabies. Instead, recognize that the worst-case scenario (my sore throat could be cancer!) is not even remotely likely, and stick to sites that offer reputable information. The websites of the American Academy of Family Physicians and the American College of Physicians are excellent and open to the public. Catch a free ride with them.
Meanwhile, current primary care providers can do a lot to help adjust to the new shortage. Every primary care physician should have a website, even if it just has updates on epidemics, downloadable forms, and basic information about the practice. This would save a lot of time in the office. Also, primary care doctors should eliminate hospital care from their regular work. Traditionally, doctors pay bedside visits to any patients of theirs who are hospitalized, in order to provide continuity in the patient’s care. But the emergence of hospital generalists called “hospitalists”—along with more enhanced communication systems—has largely replaced this need. While it’s nice for the patient in the hospital, it’s a huge and inefficient drain on a doctor’s time.
Primary care providers should also partner with urgent care centers and send all their same-day, sick patients there. This way, they stay on schedule, and their sick patients are seen right away, when it’s most convenient for the sick person.
Docs who do these things will have more patients, better informed patients, and restful nights.
Certainly, the shortage of family doctors is going to be a problem, but it also creates opportunities for both patients and physicians to improve existing healthcare outcomes, provided we take the initiative. As for finding a substitute for the deeper sense of reassurance that comes from spending real time with another human being devoted to your health—well, that we haven’t yet figured out.
Ken Murray, MD is Clinical Assistant Professor of Family Medicine at USC.

When Doctor's Face Death

December 30, 2011, 2:23 pm

When Doctors Face Death

By PAULA SPAN

A telling essay about the way doctors choose to die, as opposed to the way most of their patients will, appeared on a Web site called Zocalo Public Square last month and has been ricocheting around the Internet ever since — to its author’s astonishment.

 

I first saw the essay, “How Doctors Die,” on Twitter. Others came across it via Andrew Sullivan’s blog on The Daily Beast. It’s popped up on news sites, religious and medical sites, and probably thousands of individual blogs.

So I’m a bit late to this party, but with an excuse. I wanted to talk to Dr. Ken Murray, the retired family practitioner in Los Angeles who wrote the essay, before I posted the link. That wasn’t so easy to do, in part because of Dr. Murray’s extremely energetic definition of “retirement.” Since closing his practice four years ago — with the way medicine has changed, he told me, “each day it was a little less fun” — he hasn’t been sitting around waiting for reporters to call.
He reads three to four books a week (one recent week: an anthology of creative nonfiction, a military adventure, a Bob Woodward investigation and an obscure tome on communications). He attends 10 to 15 lectures each month. He’s a certified sailing instructor and a volunteer forester who, the day we finally spoke, had just clambered down from an 80-foot Ponderosa pine.

“How Doctors Die” was the third of three posts Dr. Murray had agreed to write for Zocalo. His first received one comment and the second two – all from people he knew. When I last checked, the third had drawn nearly 400 and has by now surely reached hundreds of thousands of readers. “I am in shock,” said Dr. Murray, who’s 59. “This was a nerve that was ready to be hit.”
Dr. Murray contends in his post that doctors know too much about the futility of aggressive end-of-life treatment to subject themselves to it. His argument is anecdotal, based on people he has known but lacking statistical underpinnings. “It’s a fair criticism,” he said.
But recently an alert reader e-mailed him a study, published in 2008 in The Archives of Internal Medicine, of more than 800 physicians who graduated from Johns Hopkins University between 1948 and 1964. Most had reached their late 60s and 70s, so questions about end-of-life treatment were not purely hypothetical.
Asked what treatment they would accept if they’d suffered irreversible brain damage that left them unable to speak or recognize people but was not terminal, the doctors overwhelmingly said they’d decline CPR, feeding tubes and a host of other common interventions. “So there is actual evidence about this,” Dr. Murray said, pleased.
He’s also pleased that the subject of how we die, doctors or otherwise, has such resonance. “Twenty or 30 years ago, it was not socially acceptable to talk about this stuff, so these discussions didn’t happen,” he said. “Now we are having them, even though we’re all uncomfortable with them because there’s so much emotion tied up with this.”
“But it has to happen,” he added. “We’re finding our way.”
We talk about this stuff all the time, of course, but rarely so eloquently. Read “How Doctors Die.” I’m sure Dr. Murray will be interested to hear what you think.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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How Doctors Die

http://www.zocalopublicsquare.org/

Nexus

How Doctors Die

It’s Not Like the Rest of Us, But It Should Be

by Ken Murray
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.
How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.
The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.
But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.
Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.
Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.
It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.
Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.
Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.
But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.
Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.
We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.
Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.
Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.

*Photo courtesy of patrick.ward04.