Text Wrestling: Letting Go
Hospice care is something that most people are more or less familiar with. Most people associate the term with the type of care that people receive when they are about to die, or so sick that no other treatment is possible for them. Although this is more or less true, there is much more to hospice care than that. Hospice care as we know it in modern times was first introduced by a doctor named Dame Cicely Saunders, who treated the terminally ill. (NHPCO.org, 2016) The first hospice center was created in London. Hospice care has advanced greatly over the course of the 1900’s, and nowadays patients are even able to have hospice care come to them, staying in their own homes while visiting nurses visit them on a daily or weekly basis. These services have proven to greatly improve the quality of life in patient’s final days.
In “Letting Go,” Atul Gawande tackles the topic of addressing what doctors should do when they know they can’t save a terminally ill patient’s life. In medicine, knowing when to tell a patient that you can’t save them is a very sensitive and controversial topic. With modern medicine, there are so many things that can be done to prolong a person’s life. However, if you’re prolonging a person’s life, are you actually making their life better, or just longer?
Gawande starts the article by introducing you to a patient named Sara. Sara is 39 weeks pregnant when she finds out that she has lung cancer through a chest X-ray. The doctors deliver Sara’s baby to get treatment started as soon as possible. Sara is 34 and has never been a smoker in her life. Her and her husband are eager to start treatment, and are hopeful. However, after several tests and scans, Sara’s doctor, Dr.Marcoux, realizes that her cancer may be worse than they thought. The cancer is not responding to any of the treatments they have tried, which is a bad sign. The more treatments that are tried, the less likely a cancer is to respond to treatment. Dr.Marcoux does not know how to tell Sara that her prognosis does not look good. It is clear at this point in the article that Gawande is trying to show how even doctors aren’t always sure how to break the news to patients that they are dying. Most of the article follows Sara and her battle with her cancer.
At this point in the article, Gawande begins to point out some statistics, regarding the history of illness, technology, insurances, and how they all relate to one another. He mentions how in the past, terminal illnesses killed people in a matter of days. However, with modern medicine, we are able to keep people alive for weeks, months, even years longer than they would have hundreds of years ago. This is all due to the technology we have access to now. But it comes at a cost and we are all paying for it. As Gawande points out in his article, “Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.” These numbers are a real eye-opener. So much money is being pumped into keeping people alive, but the question that is proposed is, what is the quality of their lives? Many of these terminally ill patients are being kept alive on ventilators with breathing tubes and feeding tubes and can’t eat or breathe or even go to the bathroom on their own. They aren’t even functioning people but yet so much money is being spent to keep them alive, but is this a quality life?
Gawande then shifts his focus in the article to hospice care, which is a big jump from the previous topic of keeping people alive on machines. He explains that hospice care is an alternative to life support, as it focuses more on keeping patients comfortable in their final days. The doctor follows a hospice nurse on her rounds to visit patient homes and check on them. His explanation and story brings a new light to hospice care, because normally when you think of hospice, you think of a hospital and elderly people in beds, slowly dying. You don’t tend to think of people in the comfort of their own homes, comfortably living their day to day lives. However, Gawande explains that although there are many patients on hospice, not all of them have accepted that they are going to die. Some of them have no choice but to turn to hospice care, as there are no other options for them, or no more treatments left to try for their illnesses. Some of them don’t want to die. Some of them have accepted their fate, though. In this section of the article, Gawande mentions a firefighter in his mid-40’s who was recently diagnosed with an inoperable pancreatic cancer, he had a very short time to live. He and his wife were very understanding of the diagnosis, and responded very well to hospice care. He spent the time that he had left in the comfort of his own home with his own family, and eventually died peacefully, surrounded by his loved ones. For those who are accepting of their diagnosis, hospice has proven to be a wonderful option.
Now and then the article shifts back to Sara, and Gawande gives us an update on her. Each update is worse, however. Her health rapidly declines, and although they know that the experimental drugs are unlikely to work, she and her family never seem to give up hope. The doctors are so doubtful of Sara’s survival, but they let her try these new drugs anyway, maybe as a way to make her feel better. Although the doctor’s had the patient’s best interest in mind, letting her try all of these experimental drugs, that they knew weren’t going to work is just a waste of insurance money as a way to pacify the patient. The family is willing to try anything to try to help Sara get better, but if the doctor knew that the treatment wasn’t going to work, then why bother trying the treatment? As stated in the article, this seems to be something that happens everywhere, as something to pacify sick patients. People are afraid of dying, and it seems as though a lot of doctors are almost afraid to tell their patients that they are going to die.
Eventually, Sara did give in to her battle. A bout of pneumonia caused an infection so bad that she just gave up. She took the antibiotics but stated that she didn’t want anymore invasive treatments. Her family eventually agreed with her decision and she eventually died in the hospital.
Gawande’s article was very well written and a very good read, summarizing very thoroughly a lot of the problems with modern medicine and also the benefits of hospice care. His article goes to great lengths to make the concept of hospice care seem much more comforting than it has previously come across. Hospice and palliative care have long been associated with the idea of death and the very ill, and seemed like a very scary thing. However, this article shows a lighter side of hospice care. Although it is inevitably a sad ending for most patients, the hospice nurses go to such great lengths to make sure their patients are happy and comfortable. It makes it almost personal, knowing that that could be me one day, or that that could be my mother one day in hospice care. Reading this article makes it seem much more optimistic that everyone can receive such amazing care if they are to ever be in a situation where they need to be placed in hospice care.
The article also put into perspective the great lengths the medical field is going to keep sick patients alive. We are keeping a lot of patients alive, but at what cost? It’s true that a lot of people are afraid to face their diagnoses, and the insurance companies are cashing in on our fears. An article from the New England Journal of Medicine states that “Between 2000 and 2012, the percentage of Medicare decedents using hospice doubled (from 23% to 47%) and hospice expenditures quintupled (from $2.9 billion to about $15.1 billion).” (Gozalo, Plotzke, Miller, Mor, Teno, 2016) A lot of money is spent keeping people alive. I think that the author hit a lot of great points about how people’s money is being used inappropriately and although it’s probably the unpopular opinion, I agree with the point Gawande was hinting towards. People are being kept alive much longer than necessary solely for the sake of their loved ones, and the quality of their life isn’t taken into account at all. I think that this is wrong, and judging by the mood of the article, it seemed as if the author did as well. A lot of people are kept alive for a long time on machines solely for the benefit of their families knowing that they’re alive. Everyone has a hard time letting go.
Works Cited
Gawande, Atul. “Letting Go.” The New Yorker. N.p., 26 July 2010. Web. 26 Apr. 2016.
Gozalo, Pedro, Ph.D, Michael Plotzke, Ph.D, Susan Miller, Ph.D, Vincent Mor, Ph.D, and Joan M. Teno, M.D. “Changes in Medicare Costs with the Growth of Hospice Care in Nursing Homes” New England Journal of Medicine. Massachusetts Medical Society, 7 May 2015. Web. 26 Apr. 2016.
“History of Hospice Care.” National Hospice and Palliative Care Organization. N.p., 28 Mar. 2016. Web. 26 Apr. 2016.