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Chocolate and Cabernet

September 22, 2014

Here’s a conversation, probably imaginary, that I might have had with my father in the last years of my grandmother’s life (she had Alzheimer’s disease):

Dad: “What should be get Grandma for Christmas?”

Me: “Well, she loves chocolate chip cookies.”

Dad: “But I need her to eat something more healthy than cookies.”

Me:  “Why?  If all she wants is chocolate chip cookies, let’s give her chocolate chip cookies.  What the heck does she need to eat healthy for?”

While I am not condoning a diet of sugar and fat for all end-stage Alzheimer’s patients, the conversation does raise an interesting question:  At what point do we quit trying to be healthy and live longer and just live?  This point was eloquently addressed in the New York Times yesterday by Jason Karlawish, a professor of medicine, medical ethics and health policy at the University of Pennsylvania.  Here is a quote:

“Aging in the 21st century is all about risk and its reduction. Insurers reward customers for regular attendance at a gym or punish them if they smoke. Physicians are warned by pharmaceutical companies that even after they have prescribed drugs to reduce their patients’ risk of heart disease, a “residual risk” remains — more drugs are often prescribed. One fitness product tagline captures the zeitgeist: ‘Your health account is your wealth account! Long live living long!’  But when is it time to stop saving and spend some of our principal? If you thought you were going to die soon, you just might light up, as well as stop taking your daily aspirin, statin and blood pressure pill. You would spend more time and money on present pleasures, like a dinner out with friends, than on future anxieties.”

The analogy of an “account” is a useful one.  People who want to be responsible with their money usually try to set a little aside every month in some sort of retirement account, against the day they can stop working and start sleeping late.  They are saving their money, or delaying the gratification they could have gotten by spending the money right away, so that they can be financially healthy later in life.  People do this with physical health, too.  They eat their vegetables, exercise, get their screening tests and take their medication as a sort of health savings account, the idea being if they are responsible now they’ll live longer and be healthier later.

But what if you work your whole life to save for retirement but never retire?  Or what if you work your whole life to save for retirement but you’re too sick once you retire to do all those gratifying things you were delaying in order to have money to retire?  What have you sacrificed for?  In a similar vein, if you denied yourself chocolate chip cookies your whole life because they aren’t good for you and might shorten your lifespan, what good is it if you can’t cash in that sacrifice when you’re old and your lifespan is no longer amenable to shortening?

Think about this when you or an elderly loved one are spending every day in a doctor’s office waiting room.  Think about that quote from “Twelve Years a Slave”, where the slave says “I don’t want to survive.  I wanna live.”  Personally, in my final years I expect my children to surround me lovingly with mountains of chocolate chip cookies and gallons of California Cabernet, not a doctor or pill in sight.



From → End-of-life Care

  1. MLWest permalink

    Hello! I came across your website because I’m considering going to med school. I’ve been an ICU RN for almost 7 years now and I’m looking for change! I appreciate your post about being a doctor vs being a nurse. Seeing that you’ve actually walked the path I’m interested in, I’m motivated to apply and see if I can get in a post bach program. Please email me with any advice! Thank you!

    • ML – I did the post-bac at UConn. I had to do two full years because my original bachelor’s is in music and my RN was a non-nurse college graduate program. Be prepared for a world of science and math purgatory! Unless you like that sort of thing. Just be careful – I thought I knew what I was getting into. I had no idea.

      • MLWest permalink

        Oh wow! And now you’re an Anesthiologist! That’s HUGE! I’m considering applying for CRNA school, or to NP school. I’m 34, not sure if I have 9yrs or more to dedicate to school now! How old were you when you made the change? In your 20s? I want to get out of bedside nursing and to have a schedule that will allow me to spend more time with my family.

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