Mortality

Perhaps the scariest thing about a new cancer diagnosis is the way that cancer makes us uncomfortably face our own mortality. Sure, we all know that none of us is immortal, but most of us never spend much time thinking about no longer being alive. However, talk to anyone who has had cancer and you’ll be hard-pressed to find a soul who has not wrestled with the question “Is my time up?”

Many a quote and song lyric speak to the idea that we started dying the day we were born. Why is it then, that there is so much fear and dread and often desperate avoidance of something so natural, something that we all must face at one time or another? Maybe it’s the loss of time that one counted on having, especially for younger patients? Or could it be loss of control and independence that we have become so accustomed to as a society? Or maybe it’s the fear of suffering that sometimes accompanies advanced cancer and other terminal illnesses? Or even a fear of what’s next after death, if anything?

Regardless of the causes, fear of our mortality is a big problem in medicine and society today. Starting even before the pandemic, the medical field has witnessed an increasing expectation of patients to live as long as possible, many times at all costs. And not just financial costs, but also the physical, mental, emotional, and spiritual costs. Maybe this stems from the “on-demand” culture we now live in, where you can get exactly what you want same day, or at the latest, next day. Why can’t it be the same for the results of our medical treatment? I want/need to live longer, so order it up for me!

This is particularly important in cases of advanced cancer, where patients and families are considering later line treatment options or clinical trials. Many times, initial treatment options can have excellent results with prolonged remissions. But when cancer recurs or relapses multiple times, it is usually smarter and more resistant to treatment. In these cases, the expectation of benefit from more and more treatment diminishes significantly.

Don’t get me wrong, there is nothing amiss with seeking out the best treatment plan to help try to fix what ails you. Medical breakthroughs are made by the generous participation of patients enrolling in clinical trials of new drugs. And some patients do gain unexpected time by trying additional treatments that may not work for most. But when the goal of treatment becomes an attempt to approach immortality, then we have a problem. When “just shy” of immortality becomes the goal, then the physician is given the unenviable, unfortunate, and doomed job of playing God.

So what do we do as a medical profession, as patients, and as a society to address this growing disconnect between expectation and reality when it comes to mortality? There are no easy answers, but we’ll explore some ideas in upcoming blog posts.