On a recent flight across the United States, a familiar song played on my iPod, Queen’s Who Wants to Live Forever. While the song clearly asks a question about mortality and immortality, that question has two derivations. The two questions are:
1. Who wants to win the prize of immortality?
2. Why would anyone want to live forever?
Some further context may help. The song was written and performed by Queen for the movie Highlander. The movie follows Connor MacLeod who was born in 1518 in Glenfinnan near the shores of Loch Shiel. He is one of Earth’s immortals who fight for the ultimate prize of omniscience. The person who wins the prize must behead all of the other immortals on the planet. As each immortal succumbs, the victor gains the strength of the fallen. That sounds pretty simple, thus, who wants the prize? Who wants to live forever?
The problem is that Connor does not always like being immortal. In the movie’s opening scene he is almost killed in battle by another immortal in a Scottish clan skirmish. Just as he is to be beheaded his clansmen stop the rival – the Kurgan. Connor, who will surely die, is taken back to Glenfinnan, but inexplicably lives. It is now his clan that wants him dead figuring that he must be possessed by the devil. He is eventually banished from the village. After this he meets a woman, Heather, who becomes his wife. He cannot have children, he’s immortal, and this is a lifelong sorrow for he and Heather. Worse, Heather grows old over the years and he does not. She eventually dies in his arms. He learns that immortals should have transient bonds. So, why would anyone really want to live forever?
OK, now you are asking what this has to do with OGME. Well, there was a recent article in the Wall Street Journal entitled "Why Doctors Die Differently." The article reported on the differences between physician’s end of life decisions versus those of the general public. There were some striking differences. Who wants to live forever? Physicians were more likely to choose conservative and palliative management when faced with low cure or survival rates. The question posed is whether physicians unique perspective, they clearly have both knowledge and experience dealing with end of life issues and watching other people die, changes their view of the question. To the general public, the prize is immortality. The medical community – doctors, nurses, researchers, pharmaceutical companies – has been in search of this prize since the beginning of time. Clearly that resonates with the public – why else would they be willing to pay so much for so little?
Some may say that medicine hasn’t furthered the immortality notion. Think for a second though about Queen’s voice Freddie Mercury. Freddie died far too young of AIDS. All one has to do is watch a Queen concert on YouTube and they will see one of the most alive people ever known. Freddie could command entire stadiums across two continents (as he did at Live Aid). Listening to him sing Who Wants to Live Forever and another poignant song, The Show Must Go On, make me wonder what his view of certain death must have been. He contracted HIV in the late 1980s and died in the early 1990s. Everyone who got HIV at that time died of AIDS or an AIDS associated illness. We all know, Magic Johnson knows quite well, that that doesn’t happen now, at least in the “developed” world. HIV is only one death sentence that has been pardoned. There are many more each year.
They lesson for physicians, physicians in training and physicians that train physicians is that the end of life is many times as important as life itself. It is also important to share the lessons of our previous patients with our current patients. It seems clear that physicians head those lessons when they make their own decisions regarding death and dying. We need to ask patient both:
1. Do you want us to do everything to make you better?
2. Are you sure that you would like to suffer more?
The answers are a matter of perspective…
