Comparison:
Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.
MD Atul Gawande writes with candor, compassion, and focus as he uses two disgraced generals as metaphoric guides as to how to battle inevitable death. In the context below you'll discover that he throws in a final train metaphor to cap his critique of how contemporary medicine approaches troublesome death processes.
Context:
The simple view is that medicine exists to fight death and disease, and this is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.
More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, ‘You let me know when you want to stop.’ All-out treatment, we tell the incurably ill, is a train you can get off of at any time—just say when.
Citation:
Gawande, Atul. Being Mortal: Medicine and What Matters in the End. Henry Holt and Company, 2014, p. 187.
(Image by Lee Aigue, base images courtesy of Wikimedia, CC 3.0,, Jan. 2025.)
Comments