The Game of Life

Since my first post, I realize that I’ve strayed from interpreting and elaborating on scientific studies. It turns out that I easily get distracted and think about a lot of not-exactly-hard-and-basic-science things. It happens. As part of clinical training in medical school last week, I was particularly touched by an exercise on coping with death. (I wrote about some other favorite clinical experiences here.)

Mentally, I keep coming back to this exercise I did on end-of-life priorities and choices. It’s well-known and perhaps some of you have done it: I was given eight cards for each of three categories (possessions, goals, and people), making a grand total of 24 cards, and I was told to write out specific possessions, goals, and people that were important to me. The “game” consisted of me imagining my own disease progression and at every stage I was forced to give up a card from each category. What disturbed me most about the whole exercise was my ability to do it. When I think about that hour, I remain deeply unsettled about how decisive I was about priorities. Worse still, it didn’t take long for me to develop a sort of ranking for specific relatives and friends; there were real names on those cards. From the outset, I found myself wanting to cheat and use extra cards for the people pile. Seriously, I got way too into this game. It’s amazing what you start thinking about when you’re able to immerse yourself in some serious pretend.

They are just things

Maybe I bent the rules a little bit by counting my dog as a possession (I mean, I was already way out of people cards) and by counting a family cabin as a possession (though it’s in some sort of trust I don’t completely understand). Each cycle, I tore the possession card in half first. At the beginning, the Swiss dishes and running shoes went, then my first white coat, and later still photographs and scrapbooks. The last two were my dog and the cabin in Maine.

Hopes and dreams

Life goals are sometimes easy to list but rarely easy to rank. What was interesting is how easy it was to tear up the cards with the goals like “visit Japan” (which I really, really want to do) and “restart piano” (I have perennial good intentions). A while later I found myself making harder decisions about community contribution and professional development, yet still found myself reaching to rip those cards long before the last couple: “marriage” and “children.” Funny how clear things become when you get right down to it.

I’m not sure how I feel about this people situation

I have no qualms about publicly stating that names of friends were torn before the names of family members. At that stage of the game, I was still able to feel calm and rational and justified. When I got down to my last four people (father, mother, sister, brother), I realized how good I was at playing pretend. Tears came to my eyes as I lifted the last few cards off the table. I’m already trying to forget about the fact that I was forced to have an order to those last cards. 

The point of the exercise was to help develop a sense of what it might feel like to be a patient with a terminal diagnosis. Maybe you are unable to keep all of your possessions as you age. As your energy wanes, you give up certain goals. You decide who you want with you at your deathbed. More broadly, though, we should all sometimes think about our priorities. If anything, we will be reminded of how our true values are not necessarily reflected by the way we spend our time. In large part, this is due to the difference between immediate needs and long-term priorities, but it still gives me pause. Sometimes the pause is rather long, I admit, given the deeply personal and critical nature of these questions. Don’t think about it too much – you need to live a little, too – but give it some consideration now and again.