By Dr. Kate Scannell, Syndicated columnist; First Published in Print: 03/15/2012
If you've been feeling somewhat anxious about our wobbly world, imagining hoof beats from the four horses of the Apocalypse every time a squirrel scampers across your roof -- you might derive some comfort in news events of the prior week.
For example, if you're reading this column on its publication date -- Sunday, March 18th -- you can rest assured that, despite what many doomsayers had predicted, the end of the world did not occur March 16th when the Large Hadron Collider CMS detector was switched on "somewhere" near the French-Swiss border.
You also might let out a sigh of relief that fiery solar storms did not incinerate the Earth to a crispy nubbin last week -- contrary to several grim prophesies.
Finally, solace may come from knowing that preacher Harold Camping announced last week that he would cease making predictions about the world's end. After spending millions of dollars informing and preparing followers for the Rapture on two separate but failed occasions in 2011, he humbly conceded that he'd been wrong to even try. He furthermore declared that "we have no new evidence pointing to another date for the end of the world."
Yes, last week was a white-knuckled, roller-coaster ride for Apocalypse spotters.
The wild ride reinforced one lesson -- people have failed for centuries to predict the moment of TEOLAWKI (the end of life as we know it). A tenacious "world of proof" continues to offer indisputable evidence of that.
A friend told me that he had constructed a small shelter to protect him and his cat should Armageddon arrive by any route. He stocked the shelter with supplies that he refreshed on schedule every so often. He even showed me an iPhone app that offered a survivalist's guide (but not a power source to supply his phone during world ruin).
So I asked him whether he had ever filled out an "advance directive for health care" -- a planning document to prepare for the inevitable EOHLAWMKI (end of his life as we may know it). I explained that an advance directive was like a highly personalized survivalist's guide -- one that he would author to spell out how he wished to deal with future calamities threatening his health or survival.
It instructed doctors what to do -- or not do -- to facilitate his desired strategy. It allowed him to choose people he trusted to make medical decisions on his behalf, should he become incapable of making them himself.
"No," he said. "I don't have an advance directive. And I don't see how that could help me if some global catastrophe annihilated everyone in the world -- doctors included."
Of course, he was right. An advance directive would prove useless during an actual Armageddon, should that occur. But what about considering its potential utility in the setting of, say, regular old "reality," which continuously unfolded, and would someday deliver him to his most certain death?
It's probably easier for him to conceive of death as some colossal, cosmic, and impersonal event -- rather than the highly private, pedestrian, and individuated experience that death occasions. And it may be easier to abide death as some looming potential threat -- instead of an impending reality with a 100 percent chance of occurrence.
All I know is that my friend has a definite expiration date -- and my guess is that it will be sooner than the expiration dates for a lot of the canned tuna and Velveeta he will leave behind in his shelter.
It's also been said that many Americans seem to consider death as "optional." If true, that magical thinking may help explain why almost 80 percent of us have not filled out an advance directive for our end-of-life care.
Magical thinking about death was in evidence in a study reported last week by the Annals of Internal Medicine. San Francisco researchers had asked 80 people to interpret typical statements that a doctor might make about a hypothetical patient's chances for survival. When provided with a high estimation of survival, people tended to interpret the estimate accurately. That is, for most people, a "90 percent chance of survival" literally meant a "90 percent chance of survival." However, when provided with a low risk of survival, people tended to misinterpret the risk in favor of a rosier picture. For example, fully 65 percent of people misinterpreted a "5 percent chance of survival" to mean variously higher chances.
Still, we doctors are probably worse than most patients when it comes to interpreting the odds of death fast approaching. Studies show that, for various reasons, we also tend to be overly optimistic about a patient's chances for survival -- and then we often add further optimistic bias when we actually disclose those estimates to patients. One study even showed that the tendency to be overly optimistic was worse when doctors had established caring relationships with patients.
Well, call me old-fashioned -- but I place my bets on a predictable cycle of human life that's been validated billions of times, over many centuries. And I think that no amount of optimism or Velveeta can shelter any one of us from the absolute certainty of a very personal death.
So, my friend, why not fill out an advance directive for health care while you wait for the next Armageddon?
=======================================================
Kate Scannell is a Bay Area physician and the author most recently of "Flood Stage."
© Copyright 2012, Kate Scannell
Readers can access an advance directive for health care from many sources, including the Coalition for Compassionate Care of California: http://coalitionccc.org/advance-health-planning.php
If you've been feeling somewhat anxious about our wobbly world, imagining hoof beats from the four horses of the Apocalypse every time a squirrel scampers across your roof -- you might derive some comfort in news events of the prior week.
For example, if you're reading this column on its publication date -- Sunday, March 18th -- you can rest assured that, despite what many doomsayers had predicted, the end of the world did not occur March 16th when the Large Hadron Collider CMS detector was switched on "somewhere" near the French-Swiss border.
You also might let out a sigh of relief that fiery solar storms did not incinerate the Earth to a crispy nubbin last week -- contrary to several grim prophesies.
Finally, solace may come from knowing that preacher Harold Camping announced last week that he would cease making predictions about the world's end. After spending millions of dollars informing and preparing followers for the Rapture on two separate but failed occasions in 2011, he humbly conceded that he'd been wrong to even try. He furthermore declared that "we have no new evidence pointing to another date for the end of the world."
Yes, last week was a white-knuckled, roller-coaster ride for Apocalypse spotters.
The wild ride reinforced one lesson -- people have failed for centuries to predict the moment of TEOLAWKI (the end of life as we know it). A tenacious "world of proof" continues to offer indisputable evidence of that.
A friend told me that he had constructed a small shelter to protect him and his cat should Armageddon arrive by any route. He stocked the shelter with supplies that he refreshed on schedule every so often. He even showed me an iPhone app that offered a survivalist's guide (but not a power source to supply his phone during world ruin).
So I asked him whether he had ever filled out an "advance directive for health care" -- a planning document to prepare for the inevitable EOHLAWMKI (end of his life as we may know it). I explained that an advance directive was like a highly personalized survivalist's guide -- one that he would author to spell out how he wished to deal with future calamities threatening his health or survival.
It instructed doctors what to do -- or not do -- to facilitate his desired strategy. It allowed him to choose people he trusted to make medical decisions on his behalf, should he become incapable of making them himself.
"No," he said. "I don't have an advance directive. And I don't see how that could help me if some global catastrophe annihilated everyone in the world -- doctors included."
Of course, he was right. An advance directive would prove useless during an actual Armageddon, should that occur. But what about considering its potential utility in the setting of, say, regular old "reality," which continuously unfolded, and would someday deliver him to his most certain death?
It's probably easier for him to conceive of death as some colossal, cosmic, and impersonal event -- rather than the highly private, pedestrian, and individuated experience that death occasions. And it may be easier to abide death as some looming potential threat -- instead of an impending reality with a 100 percent chance of occurrence.
All I know is that my friend has a definite expiration date -- and my guess is that it will be sooner than the expiration dates for a lot of the canned tuna and Velveeta he will leave behind in his shelter.
It's also been said that many Americans seem to consider death as "optional." If true, that magical thinking may help explain why almost 80 percent of us have not filled out an advance directive for our end-of-life care.
Magical thinking about death was in evidence in a study reported last week by the Annals of Internal Medicine. San Francisco researchers had asked 80 people to interpret typical statements that a doctor might make about a hypothetical patient's chances for survival. When provided with a high estimation of survival, people tended to interpret the estimate accurately. That is, for most people, a "90 percent chance of survival" literally meant a "90 percent chance of survival." However, when provided with a low risk of survival, people tended to misinterpret the risk in favor of a rosier picture. For example, fully 65 percent of people misinterpreted a "5 percent chance of survival" to mean variously higher chances.
Still, we doctors are probably worse than most patients when it comes to interpreting the odds of death fast approaching. Studies show that, for various reasons, we also tend to be overly optimistic about a patient's chances for survival -- and then we often add further optimistic bias when we actually disclose those estimates to patients. One study even showed that the tendency to be overly optimistic was worse when doctors had established caring relationships with patients.
Well, call me old-fashioned -- but I place my bets on a predictable cycle of human life that's been validated billions of times, over many centuries. And I think that no amount of optimism or Velveeta can shelter any one of us from the absolute certainty of a very personal death.
So, my friend, why not fill out an advance directive for health care while you wait for the next Armageddon?
=======================================================
Kate Scannell is a Bay Area physician and the author most recently of "Flood Stage."
© Copyright 2012, Kate Scannell
Readers can access an advance directive for health care from many sources, including the Coalition for Compassionate Care of California: http://coalitionccc.org/advance-health-planning.php