Letting Go…

I believe that when medicine cannot save your life, it should make you as comfortable as possible and allow you to live the remainder of your days with peace and dignity. Now words like peaceful and dignity aren’t clear cut medical terms but I think it is what most of us would hope for when we approach our own deaths. In Sara’s case in “Letting Go” it would have been to make her comfortable an allow her to enjoy her newborn baby, without struggling with chemotherapy and other medications. This would have meant for not only Sara and her family to “let go” but also the doctors. In fact, my impression of Sara and her husband Rich is that they both tried to stay positive and managed to maintain optimism even in the face of her diagnosis and poor prognosis. It was the doctors that seem to have a hard time letting go. They knew Sara’s prognosis was bleak and yet they kept prescribing drug after drug and procedure after procedure, many of them with adverse side effects that made Sara ill or caused her discomfort. This is where Sara missed her peace and dignity in her death. She was on medications that would at best maybe let her live another month or two but made her break out in “an extreme, nearly overwhelming allergic response” and this is on top of all the symptoms that chemotherapy can cause.

Peace and dignity also factored in Craig’s decision to seek out a physician assisted suicide in The Suicide Tourist. He faced a terminal diagnosis and after losing most movement in his limbs he refused to decline any further and ended his life. I also think this is an acceptable use for medicine in cases like Craig’s.  He maintained his dignity by not allowing himself to decline to the point where he would need feeding tubes, to have someone clean and change him, and to have his family witness his condition. He was also able to die in peace- listening to his favorite song, his wife holding his hand as he simply drifted off to a wakeless sleep.

In Sara’s case medicine could not save her life and was used to prolong it unnecessarily. In Craig’s case it was used the opposite way and ended his life. While killing you certainly isn’t the end goal in medicine at end of life, it was much more effective in Craig’s scenario. It made him comfortable and allowed him to die in peace.

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What should medicine do when it cannot save life?

After reading the article about Sara, It was truly scary to think that someone that has always been healthy from the start when it came to eating right and maintaining their physical exercise  was going through a terrifying cancer. Like any other patient, Sara did try her hardiest to fight cancer for her family and her beautiful child, and the fact that she still wanted to live. However, with all the heavy medication and multiple treatments, it still was not able to save Sara’s life. So what should medicine do when it can’t save your life?

Even though medicine was not able to save Sara’s life, it did prolong her life a little longer than without the medication. Sara would not have been able to make it through all those months if it were not for all those treatments that even though they failed, they had somewhat of a good effect on her, than having no treatment at all. If you think of it this way, the fluid in her lungs would have spread fast all over her body if it were not for the multiple treatments that Sara did.  Also I think that even though medicine can’t save one’s life, it can although help ease the pain a patient is going through during the treatment and throughout their final days as well. For instance, in the end of Sara’s treatment during her final moments when she was in pain, they gave her pain medicine to help relieve the pain even though it would still not help treat the cancer or stop her from dying. During her last few hours Sara was extremely scared of not being able to accept death and having to let go of her life. However, she ended up “letting go”, and that’s when it made me realize why the title was called that and how death is a denying culture plays a role in our lives.

 

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It’s never the right time to let go

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In the article “Letting Go” the author Atul Gawande, talks about medicine and the effects that it may or may not have on a patients condition, whether or not we need to cherish the quality of life over the quantity of years lived, and the costs that patients incur to obtain the possibility of living a few extra days, months or maybe even a year. At what point do we accept that the treatment provided is no longer working, instead of making it better it makes it worse by giving a patient and their family false hopes. Even with all the technology advancements certain illnesses and medications may work effectively on one patient as opposed to the way in which it works on another.

When a patient is diagnosed with a serious illness such as Cancer, or HIV the first couple of questions that come to mind are, How long do i have to live ? Is there a cure ? How effective is the treatment ? What are the costs ? Is there a possibility of relapse ? And in all honesty there is no correct answer for either one of these questions. A Doctor can never determine how long one has to live, nor can he guarantee that the medication or treatment provided assures your recovery.

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Doctors address patients concerns ethically which may not always be the best way. Consistent offering of medication trials to ill patients with the hope that this particular medication will be more successful than the one previously given, this may seem like the right thing to do, but when you put yourself in the patients position its harder to accept and comprehend.

Death should not be something that is prolonged, especially if a person is in suffering, physically and emotionally. When it comes to death we can only be financially prepared. It’s never the right time to part with a loved one, and as much as we try to keep them here if it’s their time to go it’s their time to go. Acceptance is key …

The only guarantee in life is death !

Fear of Letting Go

Reading, “Letting Go” by Atul Gawande has only confirmed my thoughts on medicine at the end of life. Medicine at the end of life should be there in order to provide comfort and relieve pain. I do not believe in dragging out a life that is ready to end. However, it is very easy to see how this becomes the route for many, even for those who did not wish for it, such as Sara in this short story. Fear of dying is real for many, even worse for those who face it within their presence. One may think they are ready to confront death head on when it is their time, to only change their mind at that moment.

When medicine cannot save a life we tend to disregard this information. We tend to think medicine will always save a life. If it is not the current medication or treatment, it will be another. We grasp onto this thread of hope because we are all afraid of losing the ones we love or the unknown of what happens after death. After much reflection, I have come to realize it is usually the family members who will be left behind that push new treatments when others do not work. The family must be ready to confront the disease and death of their loved one as much as the patient. Allowing curative care to be stopped may be seen as admitting defeat, as if you are allowing your loved one to die. However, that is not the case. It is merely the acceptance of another type of care, in which the ending moments of life can be lived out as one had always hoped.

Before class discussion and reading this article, hospice scared me. Now, that I am more knowledgeable I find myself an advocate. For me, the answer to this question is simple. When medicine can no longer save my life I want it to make my death bearable.  I want it to help maintain homeostasis for a small amount of time so I can say my goodbyes and part with the world on my terms. For terminally ill patients the disease controls their lives. Having a bit of the control back, given by the benefits of medicine to stop the suffering, would be an amazing gift at that point. The title of the article says it all. Being able to let go: the fear, the battle, and the pain, that is what medicine should help you do at the end of life.

My Sister’s Keeper

What should medicine do?

                For the entire twenty-four years of my life thus far, I have been under the assumption that hospitals and intensive care units were places used exclusively for helping with the recovery process.  But after reading “Letting Go” by Atul Gawande, my perspectives have shifted quite dramatically.

The story is centered on Sara, who is diagnosed with a terminal lung cancer.  The doctors who are assigned to treat her give her many different medications and treatments, and even more unnecessary false hopes for recovery.  The doctor in this story seems to be compassionate about his patients and what he does for them; however, if he had just been blunt about her prognosis, she probably would have been spared a decent amount of painful chemotherapy and radiation treatments.

So what should medicine do if it doesn’t save your life?  The answer to that is in the same story.  It should provide comfort so you can live the remainder of your days, weeks, or months as peacefully as possible.  I highly support the work that is done by hospices and palliative care centers.  The thought of a hospice may be dreadful to most people, but their job is to provide quality of life over quantity of life.  Medication should also be used to benefit the families of the terminally ill, giving them enough time to say their last words and be less devastated by the loss.

As stated in the story, death used to be a short-lived event.  In Sara’s case, just like many others, it has become a process.  We do not want to stop administering the medications because it would destroy us to lose a loved one; but instead, we watch them slowly suffer and die. As quoted directly from the story: “In the previous three months, almost nothing we’d done to Sara … had likely achieved anything except to make her worse. She may well have lived longer without any of it. At least she was spared at the very end.” This is the case in many scenarios—and we should seriously consider easing the suffering of our loved one to make dying easier.

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The Mantra: Live For Now

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Before reading the article “Letting Go” I had no concept of the issue that we have with modern medicine and not knowing when to stop. I have had deaths in my family, but I was young and was not involved in what was going on. I do remember the mentioning of Hospice when my grandfather died, but only knew it as the place where my Poppa was going to die. After learning more about Hospice, and especially after reading the short story, I would certainly choose to prepare to die rather than take on treatments that will most likely make my end of life time much more difficult. There were so many alarming statistics in “Letting Go” that really opened my eyes. By no means do I think that if I were a doctor it would be easy for me to inform people that they are going to die soon or to give them a life expectancy, but the fact that “more than forty per cent of oncologists report offering treatments that they believe are unlikely to work” frightens me a little bit. I believe that it would be extremely unfair if a doctor gave me a drug that they did not think will do anything to help me just to prolong having to tell me that I’m going to die. I, as a person, have the right to know when I should start preparing to die and so does everybody else. What people do with that information is up to them. Sarah’s case was very unfortunate. I understand her drive and will to live and to raise her baby, but maybe if someone would have sat down with her and really explained things to her and her family, she could have spent her last months with more peace and tranquility and much less pain and suffering with hospice or palliative care.

“Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while.”

When medicine can not save a person’s life, it should make the end as comfortable as possible. That is exactly what Hospice is.

“Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.”

Who knew? I certainly didn’t. The word needs to be spread and actions need to be taken to inform people so they know the steps that need to be taken in order for them to have the best possible quality of life when the end is near. People need to be more educated about the choices they have and they need to be told the truth about each choice. We need to be empowered and given the tools to ease our minds and at least try to make the end come easier.

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Reintroducing the Art of Healing and the Art of Dying (Letting Go)

Reintroducing the Art of Healing and the Art of Dying (Letting Go)

In today’s world, medical technology has developed to such an extent that it can greatly intervene and save many lives. Got into an accident? ‘We’ll save you! We have the medicine and the machines to make sure you are still breathing!’ Born premature and in poor health? ‘We can revive and make sure the baby lives!’ Have a terminal illness? ‘Don’t lose hope – here are all your options and we can do this treatment and that treatment…’ Getting ‘old’? ‘There are treatments that we can provide in order to prolong your life!’

Dying is an inevitability; but the definition of the term ‘dying’ has become muddled. Are you dying when you have a terminal illness? Should you be left to die if you got into an accident, and are very severely injured? Would you be dying without medical intervention, or would you be ‘actually’ dying when all medical intervention and care fails?

The case of Sara Monopoli in Atul Gawande’s argues the reintroduction of what doctors should pertain to do: ‘heal’. When a treatment is only going to leave a patient more fatigued, tired and infested with so many side effects – are the doctors really acting in the interest of the patient? Are the doctors really abiding to healing and easing the patient’s pain?
Too many people in the world today overestimate the power of medical technology – yes it can save lives when done right; but not every medical case is like the other and a doctor is not God.
Sara was a ‘fighter’, but ultimately did she get to die in the place, or the way she had wanted to? Sara and her family placed and invested all their hopes in the success of her treatment, but can we possibly think Sara had enough time with to spend with her family, as the treatments took so much of her time? Can we possibly think Sara died happy and content?

Sara’s case is not the first case that has ended unhappily even after extensive medical interference. What should doctors and the medicine industry really be doing when it can no longer save a person’s life?
Hospice care is shining star in medicine. Hospice refocuses on providing the ‘quality’ of life to patients – it discusses what can be done to reduce pain and still allow patients to be able to go around do daily activities of life and at the same time, be able to spend time with family and loved ones.
Doctors, should be able to sit down with families and patients and discuss the treatments available, and also the treatments side-effects etc. Doctors should request patients to discuss what they’d prefer, instead of ‘recommending’ the patient on the ‘best discourse to follow’. Ultimately doctors should stop overestimating the success of alleged treatments and miraculous patients, and be realistic with themselves and with the patients and the patient’s family.

‘What’s broken can always be fixed, what’s fixed will always be broken.’ This paradoxical statement attempts to explain that doctors and loved ones should know when to stop forcing treatments on a patient when it is causing more deterioration and strain on the patient then showing positive outcomes. When nothing else can be done to save one’s life, doctors should just focus on helping patient’s cope with their pain and help ease the pain too.

As a society too, people have to start thinking: are you really living when you are hooked up onto multiple medical instruments and medicine? If that is no way to live, then is that a proper way to die?

Reminder: Living the moments is more essential. Quality of life over the quantity is more essential.