A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era

"Dr. Robert Martensen paints a surprisingly sympathetic portrait of a noncompliant patient in his medical memoir, A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era. Her name is Diana, and she comes into his emergency room blaming her blurred vision on 'nerves' brought on by an upcoming job interview. But after a more careful examination, Martensen concludes it's more likely the onset of multiple sclerosis. 'Noooo!' she screams at him. 'Some other . . . ER doctor told me that once. You're wrong!' Diana's refusal to listen to medical advice fills Martensen, a medical historian and bioethicist, with regret three decades after the encounter. But her predicament—and that of many of the patients he profiles in this compelling memoir—makes him understand her unwillingness to be 'medicalized. Refusing to submit to her diagnosis, Martensen writes, 'likely meant that her sense of time—her time, her existence—would differ qualitatively from what she would experience if she participated fully in the rituals of chronic medical care.' Because the treatment for MS at the time did little 'to alleviate and nothing to halt or cure, why should she go down the orthodox path?' Questions like these will be painfully familiar to anyone who has faced a chronic or terminal diagnosis, or sat at the bedside of someone who has. Although medical science offers such patients more treatment paths and promises of hope than ever before, choosing among them, particularly in our strangely commodified role as 'health care consumers,' can seem more confusing than ever. 'Dying is not what it was in the 1950s or even the 1970s, as technology has transmuted the process from something that doctors and patients and their families could readily perceive into a range of contingent possibilities that often leave everyone in a quandary,' Martensen writes. Clearly an advocate for greater transparency between physicians and their patients, he collects case studies that suggest that's not always what we're getting . . . This thoughtful volume doesn't offer all the answers, but against the relentlessly upbeat marketing of high-tech medicine, it does provide a challenging second opinion."—Laura Billings, The Star Tribune (Minneapolis)

“A Life Worth Living is a deeply engaging book. It can be read as a self-defense manual. In fact it should be read by, say, anyone over forty-five because we are all destined to do battle with the medical industrial complex which seems quite confused about helping us out of life. Martensen, who is both an M.D. and an historian of medicine, gracefully illumines the problems we all face.”—Jim Harrison, author of Returning to Earth

“A Life Worth Living is a treasure. Robert Martensen tells compelling stories of people who are at once remarkable and familiar, and distills practical wisdom for living with serious illness. Their experiences illuminate common dilemmas and difficult decisions and shine a light on the wondrous and perilous world of contemporary medicine. Martensen writes with the insights of an experienced clinician, the perspective of a historian, and the voice of a close friend.”—Ira Byock, MD, author of Dying Well and The Four Things That Matter Most

“This book looks straight in the eye at uncomfortable truths, yet it does so in an intimate, almost caressing way. The results provoke and make this book one of the few that may change how we see the world, and how we think.”—John M. Barry, author of The Great Influenza

“Once a straightforward process, dying has become a minefield, despite—nay, because of—medicines best efforts to sustain life in the face of overwhelming odds. Thus, physician and bioethicist Martensen worries, many people diagnosed with a terminal illness may not be receiving all the information they need to make informed decisions. Indeed, they may not fully comprehend the hopelessness of their situations, either because they are not hearing, or more likely, because physicians are hedging the responsibility to tell the unvarnished truth. Consequently, what ensues is too often a painful and futile battle including unnecessary tests, interventions, and drug or device trials that make what is left of the patients life not worth living. Just where the balance point lies between hegemony and patient autonomy becomes murky at best when each participant in a patients final care is marching toward his or her own goals. An ever-compassionate Martensen makes it apparent that the thorny questions need asking, but even more apparent is that there are no easy answers.”—Booklist

"Using a variety of sources, including Duncan's autobiographical writings, Jones provides context for her examination of this complex woman. It includes recognition of the differing sensibilities of Americans, Europeans, and Asians of the time that spanned the turn of the 20th century through the opening years of the Roaring Twenties, as well as the individuals closet to Duncan: siblings, lovers, students. There were many visual artists and theater people who admired Duncan's energy and insight, among them Ashcan painter Abraham Walkowitz. His thousands of sketches and paintings of the dancer in full flight served as resource material for Jones. Duncan, in her flowing Grecian gowns and unfastened hair, is depicted bounding across multiple panels on many pages in Jones's often witty black-and-white images. This is a fine and balanced account for dancers, artists, and those interested in American rebels."—Francisca Goldsmith, Halifax Public Libraries, Nova Scotia, School Library Journal

“A physician, medical historian and bioethicist, Martensen pulls no punches: beyond the marvels of modern medical technology lies a treacherous morass of ethical, moral and spiritual dilemmas most of us are not ready to even consider: whether to opt for aggressive treatments, when to stop them, and how to die well. Too often the choice of aggressive treatment and heroic measures becomes an extended death by intensive care in grim hospital units designed more like prisons than places of healing. Thoughtful and compassionate, Martensen narrates poignant case studies, such as that of Marguerite, who undergoes ineffective surgeries and drug trials for advanced breast cancer but has debilitating side effects. The author lays blame across the board, from patients with unrealistic expectations and doctors who don't explain treatment options fully, from profit-driven hospitals to an insurance bureaucracy that spurns routine health maintenance. Martensen makes his case with clear, compelling writing that never flinches from his conclusion that some things you just can't win the battle against; you can only hope for quality of life until the end.”—Publishers Weekly