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Thy Will Be Done
PREFACE: Death is the proverbial 900-pound gorilla in all of our lives. We generally prefer not to think or talk about it, which isn’t a problem—except when death visits us. To what used to be a natural or, at least, a minimally manipulable event, contemporary medical science has added a variety of life-extending options, many of which cause prolonged oblivion, pain, family disruption, and expense. In response to the advent of life-extending technologies, instruments known generically as an "advance directive" (or "living will") have been developed, allowing us to express our wishes about our deaths, including the rigor of interventions and who should make decisions if we cannot. Despite the presence of such documents, three observers from the front lines of terminal illness report that all is not well. First, physician Victoria Sweet tackles the issue with a set of "terminal" vignettes—some of which prove less than terminal—and describes how she has framed her own advance directive. Then David Muller, who is part of a visiting doctors program, describes how even the best of patient-doctor relationships can go wrong in the face of death. Finally, sociologist Margaret Nelson reflects on her difficult role as the proxy for a dying friend and what the process requires of all of us.
YELLOW AND VISCOUS, the bag of liquid nutrition went by, held aloft by the ambulance driver. With his other hand, he pushed the gurney holding the next admission, a long, angular figure under sheets, closely followed by a sweating, middle-aged man who carried a book. I left my office to look at the new patient, a gaunt woman in her early eighties, her hands tied to the bed rails, and blue eyes roving the ceiling. The man introduced himself as her son, and could he talk to me privately?
The spectral figure in the bedclothes was, it seemed,
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