Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [65]
But two years later, the levels of happiness of these markedly different groups were both similar to that of the control subjects. There are two explanations for this surprising finding. The first is the “contrast effect.” We experience our current state more profoundly when we contrast it with how we were most recently. Someone who is not rich on Tuesday and wins the lottery on Wednesday profoundly experiences the sharp contrast in the immediate rise in his net worth. Similarly, a person who was dancing Saturday night and then hit by a drunk driver on the way home, waking up in the hospital on Sunday morning unable to move her legs, experiences her paralysis in a most devastating way. But over time, the lottery winners find that subsequent events, like buying a new car or taking a vacation to an exotic locale, don’t have the same impact and frisson as that exhilarating moment when they won the lottery. Paraplegics experience subsequent events in an opposite way. Attending a family milestone, like a child’s wedding, or competing in the wheelchair division of a marathon is experienced as a joyous triumph.
Along the same lines, many psychological studies show that we regularly underestimate our ability to adapt. People without a disability rate the “utility” or “value” of life with a particular medical problem significantly lower than those who actually live with the disability. For example, blindness is thought to be much worse by those who have sight compared with those who have lived without sight for many years. The same is true of a colostomy after bowel surgery. Most healthy people recoil at the idea of such an outcome and assign a lower “utility” or “value” than those who have one, who see their quality of life as much higher. Human beings are extraordinary in their skill at adapting, finding “value” in their lives, drawing on untapped reserves of resilience.
“I mean, the quality of my life now compared to what I had before I developed muscle disease might be considered very poor,” Paul told us. “But you know, I wake up every morning and I’m happy to be here. It’s great. You know, I’m just happy to be able to do what I do. When I was healthy, I probably would have said I never would want to live this way. Life is still a miracle.”
Eight
End of Life
Traditionally, physicians and families shielded patients with life-threatening conditions from candid conversations about dying. Doctors or families often made decisions to continue or to stop treatment without consulting the patient. In 1983, a presidential commission released a landmark report entitled “Deciding to Forgo Life-Sustaining Treatment,” which called for a change in this approach to care. The report urged doctors to speak directly with patients about CPR, intubation, and other aggressive measures that could keep a patient alive. The advance directive, or “living will,” provided a framework in which patients could specify their own preferences about what care they wanted or would forgo when faced with a life-threatening disease, and such directives became widely adopted. This document also designated a family member or friend to serve as a surrogate should the patient become incapacitated and unable to make decisions for herself. Underpinning the living will was an assumption that much of the complexity and stress of making decisions about intensive treatments would be solved by specifying one’s wishes in advance. But considerable research has since raised doubts about relying on advance directives.
Mary Quinn had planned every detail of her funeral down to the clothes she would wear in her casket. When she was sixty-four years old, a librarian living in Wisconsin, she had been told that she had three to six months to live. That was ten years ago. The diagnosis was cancer of the bile ducts, a tumor that rarely is cured by chemotherapy or radiation. A slim woman of medium height, with sparkling blue eyes and graying blond hair, Mary had