Prognosis

Most Americans live well into their 70’s, 80’s or 90’s. Those with disease will likely die sooner. But how much sooner? How do we know? Which cancers kill fast? How bad is heart failure? How fast does dementia progress?

Prognosticate = pro-forward, gnosis-knowing.

Even the best doctors are imperfect, or unwilling to give you hard and fast numbers. While having less than 6 months to live is a criteria for Hospice, most people don’t embrace hospice - or only very late. a week or two, and don’t really benefit from what it offers. How can you get an honest estimate? Embrace a “tough prognosis” well? Adapt to it bad news? (see Psychedelics and Dying last page)

UCSF has an eprognosis tool that is evidence based, if focused on particular situations.

Death doesn’t have to be an enemy or a defeat.

Ways we Die

Most doctors, for themselves - given a choice want a rapid decline over a few months - maintaining mental capacity - after we have lived a full life. Few want to live into Dementia or Major Disability. How does planning help? How can you get the truth about a disease course without the sales pitch and eternal “Hope, Dope and Cope”. Stephen Jenkinson in Die Wise does a masterful job discussing the topic. Atul Gwande in Being Mortal describes his own process (as a physican) with his father and Lung Cancer.

Where we die

Most Americans die in Hospitals (75%) , despite their overwhelming (75%) wishes to die at home. Some of this is financial (the system bills for more if you are in a hospital and we are “doing things” to you). Some of this is fear based, “can we really support Grandma at home?”

How can you have agency and choice in this? What would need to be in place for you to remain at home? How can you advocate for this?