Culture Shift

By Dr. Patrick Macmillan, MD

As a student of history, I always search for historical references to position popular culture into its proper context. Most of us can recount our childhood history lessons and tales of the Spanish Explorer, Ponce De Leon, and his quest to find the “Fountain of Youth” in North America in the 16th century. It turns out that Herodotus, The Father of History, wrote about such a fountain in the 5th century BC.

Our psyche and consciousness is woven with the notion of immortality or ever-lasting youth. My close attention to mortality was sparked after reading Atul Gawande’s book, Being Mortal. It’s a fantastic read on many levels, but I was struck by his way of looking at mortality and its natural connection to our human experience.

It is natural for humans to be connected to our bodies, our minds and the earth as we traverse the myriad paths of life. Survival is a primal instinct. But just as the sun, with its infinite power, is the engine that moves and lights our planet, it can also be the very thing that creates disorder in our DNA that gives birth to certain life threatening cancers in individuals with too much exposure. Mortality and immortality, by all accounts work to oppose one another. But do they? Can our fear or lack of acceptance of mortality create irrational expectations on the medical profession? Somewhere a balance needs to be struck between the two concepts.

It seems at times that modern medicine has cracked the code of mortality. There are many advances in cancer care, life-extending medications and interventions that allow individuals to live today when only fifty years ago it surely would have meant a quicker ending. Deepak Chopra, the American author and champion of “integrative or alternative” medicine, wrote the book, Ageless Body, Timeless Mind. In this book he writes about defying the aging process on a cellular level.

Our human experience bathes in the pool of immortality, whether it exists on the physical or metaphysical plane. I see individuals every day in the hospital who are facing their own mortality and asking the question, “How much time do I have left?” They are faced with an incurable disease that medical science cannot solve. Many times the questions are less dramatic and involve probing the disease course, prognosis and what can be done to slow down the progression and lessen the physical and emotional burden. It’s often a delicate conversation, but one I take very seriously.

There is an element of culture change the field of medicine faces. It involves the “taboo talk” about death and dying. About mortality. I have spoken to many individuals throughout my career about health, illness, and death. In all three instances I have always found that honesty serves me and the patient best. I am always thrilled when we have treatment options for patients. But I am equally thrilled when we don’t have a treatment for a disease, but still have options to comfort patients and foster quality of life. Telling a patient, “We have no more options” is never acceptable because we can always do something to alleviate the suffering of individuals even when extending life is no longer possible.

We are standing on the shoulders of history. Our culture constantly changes and adjusts to technology and the shifts in time. Mythology, dreams, and spirituality shower our experience with reassurance that this life has meaning, much greater than the mundane noise of the modern world. Embracing mortality allows us to be at peace with ourselves, the world and whatever awaits us beyond our own dimensions.

Dr. Macmillan is the Chief of Hospice and Palliative Care as well as the Fellowship Director at the University of California San Francisco in Fresno, CA. He is also the author of Palliative Care: A Different Kind of Hope.