Fighting the good fight – or not.
Atul Gawande, in an article for The New Yorker, writing about the soaring cost of health care, looks at the role dying and the terminally ill play in those costs:
Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit. … In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.Technology sustains our organs until we are well past the point of awareness and coherence.
Death is the enemy. Though it’s not just death in the literal sense. Admitting defeat can be hard, and refusing to give up can cost us dearly. Whether the President or Congress continues to escalate a war in the hopes of finally turning it around, or someone stays in a troubled relationship in the hopes that things might just get better, it’s not easy to raise the white flag.
Maybe it’s a runaway heroic impulse. Or the self-perception bias that show people tend to overinflate their abilities. In simple terms, we can call it denial, or hoping for a better outcome. I’ve coached managers who just couldn’t let go of poor performers on their team, even as team morale and productivity sunk. And I’ve sat in numerous faculty meetings, discussing a struggling student with the conversation yo-yoing between an overly optimistic assessment and an overly negative one, with the actual truth of the situation beyond anyone’s grasp. Predicting a better outcome is a hard habit to break. Gawande reports on a study by a Harvard researcher who
asked the doctors of almost five hundred terminally ill patients to estimate how long they thought their patient would survive, and then followed the patients. Sixty-three per cent of doctors overestimated survival time. Just seventeen per cent underestimated it. The average estimate was five hundred and thirty per cent too high. And, the better the doctors knew their patients, the more likely they were to err.
I have a joke with one of my cycling buddies. Sometimes around the 75 or 80 mile mark on a hard day, one of us turns to the other and say, “I’m just going to have a little lie down here on the pavement. Go on, I’ll catch up.” It’s a macabre joke at the expense of hypthothermia victims who often do fall prey – fatally so – to the desire to stop. But maybe giving up is a heroic act. Fighting when you know you are going to lose is self-harming, as any good predator with teeth and claws knows. Knowing when to fight and when to fight the impulse to fight is both a life – and death – enhancing ability.
Julie, that is a wonderful posting.
Knowing when to give up. Knowing when to fight the impulse to fight…thanks for the inspiring start to the day, and for not yet lying down on the pavement – though when you do, enjoy the rest.
Susan
Thanks Susan. I’m not sure I’ve figured out when to lie down on the pavement and when to keep pedaling, but I’m working on it.
Staying or leaving – my assessment is that there is insufficient support to assertively make those choices – let alone take the time to create a plan for that change, that is compassionate and kind to self and other.
Interesting discussion.
Thanks Julie.
Johanna
Hi Johanna, do you mean staying or leaving a relationship? And support of or by…. ? it does get very tricky and difficult to know for sure… as C.S. Lewis writes, ‘ride with our backs to the engine.’ that is, condemned to retrospective knowing!
Hi Julie
I like your encouragement to know when to fight and when to take a rest or letting go, which both can be dying little deaths, however which for me is not the same as giving up.
I wonder however, when do you know best? Really retrospectively? I have the experience that it is more in the moment, now, even if it very often takes me some time (and repetition!) to trust my feeling/knowing and act on it.
Barbara
Hey Julie,
I love your thoughts on this topic. I guess letting go is also about negotiating how to “let go” of a situation and not let go of the “high dream”. Whether that’s about having great employees, riding a great race or being in the “perfect” relationship. My two cents, Lynne xo
Thanks Lynne – that would definitely take the conversation further: how to let go without letting go of the high dream, but making it achievable. Something to work on for sure!