February 1956: Speculator Ski Area, Adirondack Mountains, New York State.
I was a 7 year-old boy who herringboned up to the rope tow, grabbed the rope, and didn’t let go, until my skis hit the edge of a rut, 50 yards later, and I fell. Unlike the 100 prior times, however, I got back up, grabbed the rope, immediately falling head first. A third time, I went another 100 yards, the fourth, I fell again, but on the fifth. I finally made it to the top, letting go, jubilant. For the first time, I had made it to the top of the hill. I later became an expert technical skier, but I never forgot that 7 year-old boy.
July 1960: Massawepie Boy Scout Camp, also in the Adirondacks, on the swim dock, final test for my Lifesaving Merit Badge. I failed to rescue the instructor, double my weight, on my first attempt. The second time, I grabbed the skin of his armpit to hang on. He yelled, “oh, you learned that trick!” throwing me off. I should have kept trying, but I quit. I earned the merit badge back home. I always regretted quitting that day.
I saw a “fluff” post on Facebook: “You can’t fail if you don’t give up.” Not true. Moreover, quitting is not invariably wrong. Sometimes, one is better off giving up and failing. Sometimes, one is not better off by succeeding. Our society believes that hard work is always rewarded and that continuous trying a virtue and quitting a vice. Sometimes it is true, other times, it is not:
1. Margaret Mitchell tried 38 times to get Gone with the Wind published; J.D. Salinger and Agatha Christie’s works were also rejected before finally accepted.
2. The inventor of the intermittent windshield wiper switch, Robert Kearns, persevered and won $30 million for patent infringement. His wife divorced him and he spent $10 million in the 14 year process. He didn’t quit and was vindicated. Having spent more time with lawyers than I would like, I’m not sure a 14 year battle with lawyers and divorce was worth the $2 million a year he made was worth it, but others may disagree. I cannot put a dollar cost on a divorce and years spent in acrimonious debate.
For every successful athlete, singer, and entertainer there are hundreds who worked as much, maybe more, and never made it. One may say, “Yes, but the next time, they might have succeeded.” Perhaps. To me, there are few things sadder than those who persevered when they should have quit: Michael Jordan and Joe Paterno come to mind. Age is real, and the infirmities that come with it.
Is quitting bad? Is it worth throwing good money after bad, good time after bad? At what point ought one give up?
I failed as a statistical consultant, because I knew nothing about marketing. I then became interested in patient safety and medical error reporting, but after 5 years of trying to develop a confidential reporting system, writing legislation introduced in the Arizona House for two years, I quit. In retrospect, I had no chance, medicine wasn’t ready to learn from errors; perhaps we will some day.
What happened as a result of my failing? When my parents’ health declined, I was there for them. When I decided to see places in the world that meant a lot to me, like the Sandhill Crane migration, Isle Royale, the Arrigetch Peaks, total solar eclipses, and the National Parks, I did. I worked on my writing, won two awards, and asked to write for the medical society, which I did for 9 years. Those writings are here on the blog, my later articles better than my earlier ones. I became a better writer because failure gave me time to write, time to discover writing was my way to both relax and communicate.
I failed to write a book in 1983, 720 pages, typewritten, about a my experiences serving aboard a Naval ship. The Naval Institute Press was tentatively interested, asking me to revise it. Sadly, after my revision, they turned me down; concurrently, a young man named Tom Clancy was submitting material to them. I quit writing and concentrated on my medical practice, where I succeeded so long as I subjected myself to unreasonable hours, malpractice suits, hurry, arguments about compensation, and constant interruptions. At 43, I decided to quit, one of the best decisions I ever made.
I worked for the Forest Service in Minnesota for six months, more content than I ever dreamed possible, returning to become medical director of a hospital, a new world, until I quit again, five years later, to become a graduate student in statistics. When I left medicine, I lost money, power, and influence. I obtained my Master’s, although had I known I would fail as a statistician, perhaps I might have quit. From failure, I entered a new world, not only writing, but volunteering, becoming a substitute math teacher, teaching English on line to people in 90 countries, and learning German.
Stopping aggressive treatment of dying patients was my greatest contribution to medicine. I knew how and when to end life support for patients with irreversible brain injury, long before hospice and The Hemlock Society. Some doctors save lives, but others know when it is time for a patient to die. Germans call it “ein schöner Tod;” we call it a good death. I used the word “die,” not “pass on” or “expire,” because DIE is the strongest verb, the only one that belongs with “death.” I knew when it was time to let go, but I also respected the wishes of those who opted to continue. Recovery from coma depends upon age, length of time, and cause. There are specific indicators that highly predict irreversible brain injury.
It is not euthanasia to quit treating; indeed, it is dying naturally, rather than with feeding tubes inserted into the abdomen, treating pneumonia, urinary catheters, bed sores, with no possible chance of returning to a normal life. Many spouses didn’t know they had a choice and were relieved when I gave them one. How did I know? I had studied the neurological literature extensively about coma when I trained. I knew the probabilities, I talked to patients and their families, heard often “he never wanted to be like this,” and discontinued life support, without discontinuing dignity or caring. There was a sense in medicine that once a tube was placed, it had to stay. I had no trouble removing tubes when I was certain of the prognosis and the family agreed. The act was neither easy for the families, nor for me, but I knew how important this final decision was for families. When my parents reached this stage, when “the door out” opened, I allowed them to go through; I kept my promise to them. I knew when to quit.
Hanging on to a rope tow or a drowning person is worth persevering; knowing when and when not to persevere is a definition of wisdom. Perhaps that should have been posted on Facebook.
Boreal B[l]og 
February 11, 2014 at 01:06 |
Amen, and amen.
It’s not easy to know when to let go. Having a physician who will tell you that what you know is right really is right is a priceless gift.