Susan Sontag's choice for aggressive care

David Rieff's story on his mother, Susan Sontag
What my mother wanted – which was to undergo any treatment, no matter how terrible, that promised a cure for her disease – would probably have been viewed skeptically by a physician schooled in what Dr. Jerome Groopman calls the "bean counting" of evidence-based medicine. But doctors like Nimer and Groopman hold that their mission is to try to treat their patients as their patients want to be treated until doing so can be called with assurance (rather than in terms of probability alone) medically futile.

Obviously, there is a cost to this. In opting for treatment – in her case, a bone-marrow transplant – my mother suffered far more physically than she would have had she opted for palliative care alone. But in honoring her wishes, without for a moment understating the risks, her doctors opted for treating her in the full, human sense of the word.

Advice: Find a doctor who takes to heart your preferences about risks and benefits, and the degree of aggressiveness you want in your care.

Browse for related stories in the index at the very bottom of this page, or read another story from David’s book.

Thanks to David Rieff for the source story in Sunday's New York Times Magazine, drawn from his book, Swimming in a Sea of Death: A Son's Memoir.

She wanted the science as well as the magic: Susan Sontag's patient-doctor relationship

David Rieff's story:
When my mother [Susan Sontag] found out she had myelodysplastic syndrome, the terrible blood cancer that eventually took her life, she oscillated between numb despair and acute panic. When she was panicked, nothing those who loved her did or said could calm her down, let alone console her. And yet we soon learned that if we could reach Stephen Nimer, her principal physician at the Memorial Sloan-Kettering Cancer Center, by telephone, or if, better still, Dr. Nimer could make the time to see my mother, however briefly, her awful distress would abate – at least for a while.

Observing my mother's exchanges with Dr. Nimer, I could not help wondering why what he said consoled her. For he never played down the lethality of the disease, nor did he hold out false hope. Doubtless, Dr. Nimer's long experience with gravely ill people, the hard-won human skills he acquired over decades of practice, played a central role. The comfort my mother derived from speaking with him was also due to her own very traditional conception of their relationship. She had no time for alternative medicine, nor did she believe that her will would somehow be strong enough to counter the scientific realities.

But my mother's relationship with her principal doctors was only fully effective because in some ways it was shamanistic. Of course, she wanted the science as well as the magic….

Advice: Find a doctor who knows both medical science and the magic of consolation.

Browse for related stories in the index at the very bottom of this page, or read a compassionate care story.

Thanks to David Rieff for the source article in today's NY Times Magazine, drawn from his book, "Swimming in a Sea of Death: A Son's Memoir."