Month: October 2018

Life and Death

Ryan Sargent

How do you tell someone they are going to die?

How do you tell someone that they are going to die? How do you ask them how do they want their final months or days to be? Does longevity of life matter more than the quality of life? What should medicine do when it can’t save your life? These are difficult questions to ask someone or ask yourself. Atul Gawande sheds some light on what doctors, patients and the patient’s families should do when medicine can’t save your life. Gawande is a surgeon and a writer and in this article, he tells the stories of multiple people all from very different lives and different ages and different types of illnesses. The one thing that all these people have in common is that they all on the tail ends of their life. They all have some kind of terminal illness.

As an example of having a difficult conversation between a doctor and a patient Atul Gawande tells the story of a woman named Sara Monopoli. Sara Monopoli was pregnant with her first child when she found out that she was going to die. Her lung collapsed, and her chest filled with fluid. The doctors tested the fluid to see if it was an infection, but it was non-small cell lung cancer. She had done nothing to have this happen. Never smoked or anything. Her cancer was advanced and spread to lymph nodes and the cancer was inoperable. They tried everything to save her. They tired chemo, new drugs, and surgeries and nothing worked. The drugs she was given was just making her weaker. She didn’t have the strength to walk down a hallway. At some point the doctors and here need to find an alternative to aggressive treatment like hospice care or palliative care

Even though hospice care is one of the better options for patients that don’t want to suffer and go in peace a lot of doctors don’t recommend hospice care for several reasons. One of the most important reason is that doctors are trying to keep patients alive as long as possible in order to either make more money or because they are help save the patient’s life. I feel like modern medicine is so caught up in trying to keep the patient alive for as long as possible. Whether this is due to the fact the more the patient comes in the more money the doctors will make, or the doctors actually care deeply about the patient life and want to cure them I do not know. In Letting Go Gawande discusses ways doctors and patients can discuss “end-of-life wishes”. In paragraph 108 Gawande gives four yes or no questions physicians can ask the patient about end of life.

1. Do you want to be resuscitated if your heart stops?
2. Do you want aggressive treatments such as intubation and mechanical ventilation?
3. Do you want antibiotics?
4. Do you want tube or intravenous feeding if you can’t eat on your own?

These questions and having these difficult conversations about end of life care with patients and their families is very hard for doctors. Someone that has had thousands of these difficult conversations is Dr. Susan Block. She is a palliative-care specialist and is nationally recognized in training doctors in “managing end-of-life issues”. Block tells Gawande in paragraph 120 “You have to understand, a family meeting is a procedure, and it requires no less skill than performing an operation.” Block explains that doctors are so caught up in what people want and laying out the facts. Instead, Block says that “You are not determining whether they want treatment X verses Y. You are trying to learn what’s most important to them under the circumstances.” This brings up the question of what happens when these conversations only happen with patient and they don’t happen with the family.

For example, when I was young, around five or six my grandmother was very sick. My family and I were visiting her, and we had to wear scrubs and insure that we didn’t get her sick because her immune system was weak very. I remember being in the room and she seemed to fall asleep and all of a sudden, we were rushed out of the room. I was so young I didn’t realize what was happening. I stood outside of the door to her room confused as nurses rushed into the room and my grandfather was telling the doctor to do something, and the doctor said no. Then I was pulled away from the room from by my dad on the verge of tears. All I know my grandmother was alive and well two days later. She passed away six months later.

I found out the reason why the doctor refused to do anything was because my grandmother checked the box DNR (Do Not Resuscitate). I didn’t find this out till I was in middle school I never knew why people would ever not want to live longer. Isn’t that something everyone want’s? I couldn’t fathom that she would want to leave us. I then read the Letting Go. After reading Letting Go I then started to understand what my grandmother was probably thinking when she checked DNR. She was in a hospital and she knew that she was going to die soon. She might have wanted to die. She might had just given up and accepted death.  These are all questions that I think any of my family members would like to ask her. I would like to ask I would like to ask is why did she check DNR.

There are so many things she could say if she could answer. I would like to think that she didn’t want her grandchildren see her suffering any longer. Even though she lived six months after that incident her life wasn’t great. she spent those months in a hospital bed. Yes she was breathing and talking and could laugh and smile. But I don’t think she was happy. She seemed sad before we’d walk in. Almost like she was sick of life. Is that a good quality of life? Should she be trying to live out the rest of her life at home surrounded by family? I don’t think that this a good way to be living. I would rather have a short quality life than a long life. Living is much more than just having a heartbeat. Living is going out for dinner with family. Living is doing want. Living is being happy with your position in life. If that is in a hospital bed in your final days, months, or years as long as you are happy. At one point all of us are going to have to make the decisions for a loved one or ourselves and it comes down to what makes you happy.

How do you tell someone that they are going to die? How do you ask them how do they want their final months or days to be? Does longevity of life matter more than the quality of life? What should medicine do when it can’t save your life? These are difficult questions to ask someone or ask yourself. Atul Gawande sheds some light on what doctors, patients and the patient’s families do when medicine can’t save your life. Gawande is a surgeon and a writer and in this article, he tells the stories of multiple people all from very different lives and different ages and different types of illnesses. The one thing that all these people have in common is that they all have is that they are all on the tail ends of their life. They all have some kind of terminal illness.

When I was young, around five or six my grandmother was very sick. My family and I were visiting her, and we had to wear scrubs and insure that we did give any germs and bacteria to her because her immune system was weak. I remember being in the room and she seemed to fall asleep and all of a sudden, we were rushed out of the room. I was so young I didn’t realize what was happening. I stood outside of the door to her room confused as nurses rushed in to the room and my grandfather was telling the doctor to do something, and the doctor said no. Then I was pulled away from the room from by my dad on the verge of tears. All I know my grandmother was alive and well two days later. She passed away six months later.

I found out the reason why the doctor refused to do anything was because my grandmother checked the box DNR (Do Not Resuscitate). I didn’t find this out till I was in middle school I never knew why people would ever not want to live longer. Isn’t that something everyone want’s? I couldn’t fathom that she would choose to leave us. I then read the article Letting Go. After reading Letting Go I then started to understand what my grandmother was probably thinking when she checked DNR. I started to think if I was in her position in a hospital bed, with tubes coming out of her arms and her nose, in constant pain, not around family and friends. Alone with machines keeping her alive. For what the next day to wake up in the same place not having strength to get up and go to the bathroom or go outside and breath some fresh air. I thought a lot about how I would want to spend my final days, months, or years. Would I want to be in a hospital bed when I already know the end is inevitable?

I am a realist. I can tell when its time do stop and find another way to do something. When it comes down to it and you get the news that you have a terminal illness and you know how much time you have left with lots of treatment and how much time you have with no treatment. At one point we all have to face this whether it a loved one or yourself. Without treatment you could extend your life and be in a hospital bed at the end. Or you refuse treatment and be at home at the end of your life.  What one would you choose? How do you want to spend it? Do you want to just extend your life? Do you want to be at home with family? What constitutes living?

Atul Gawande tells the story of a woman named Sara Monopoli. Sara Monopoli was pregnant with first child when she found out that she was going to die. Her lung collapsed, and her chest filled with fluid. The doctors tested the fluid to see if it was an infection, but it was non-small cell lung cancer. She had done nothing to have this happen. Never smoked or anything. Her cancer was advanced and spread to lymph nodes and the cancer was inoperable. There is no cure for lung cancer this far along. Sara tried chemo, new drugs, and had surgeries to drain the fluid around her lung (that didn’t work) so they put a permanent tube in her chest. She went home in between chemo cycles. She then came back to the hospital for and the tumors in her lung, chest and lymph nodes had grown a lot. She then tried another new drug that on average extended life by two months from year. She didn’t have the strength to walk down a hallway. And for what? Two extra months? A month or so after she started the new drug she had a CT scan that reviled that it didn’t work. The cancer had spread to both sides of her chest, to her liver, to the lining of her abdomen, to her spine. This part of life doesn’t make sense. Such a wonderful human that just had a kid and is now in this situation.  What now? Do they try something else or do they quit? They tried so many things and it still hadn’t worked. And at this rate the drugs that they are giving that are supposed to make her better are having side effects are making her weaker. Is this living?

Gawande explains how Sara and her doctors are trying to keep her alive long as possible. What would you do? I feel like modern medicine are so caught up in trying to keep the patient alive for as long as possible. Whether this is due to the fact the more the patient comes in the more money they will make, or they actually care deeply about the patient life and want to cure them I do not know. To me living constitutes as doing what I want to do when I want to do it. Like going out and  It constitutes as having some sort of independence over simple and easy things. Like eating, going to the bathroom, and bathing. Living to me has the most important things around. The most important things to me in order my health, my family, and my friends. If my health is gone I would want my family and friend to be there for me and take me places and not having the medicine that is supposed to make me better is making weak you just can’t move. That is living. Being with friends and family is living.

Medicine can do so much for people that are sick. But what should happen when medicine and doctors and surgeries isn’t enough. Should you just give in? Should you do everything possible to extend your life? What should matter more at the end of your life quality or longevity? When I was young, around five or six my grandmother was very sick. My family and I were visiting her, and we had to wear scrubs and insure that we did give any germs and bacteria to her because her immune system was weak. I remember being in the room and she seemed to fall asleep and all of a sudden, we were rushed out of the room. I was so young I didn’t realize what was happening. I stood outside of the door to her room confused as nurses rushed in to the room and my grandfather was telling the doctor to do something, and the doctor said no. Then I was pulled away from the room from by my dad on the verge of tears. All I know my grandmother was alive and well two days later. She passed away six months later.

I found out the reason why the doctor refused to do anything was because my grandmother checked the box DNR (Do Not Resuscitate). I didn’t find this out till I was in middle school I never knew why people would ever not want to live longer. Isn’t that something everyone want’s? I couldn’t fathom that she would choose to leave us. I then read the article Letting Go by Atul Gawande. Gawande is a surgeon and a writer and in this article, he tells the stories of multiple people all from very different lives and different ages and different types of illnesses. After reading Letting Go I then started to understand what my grandmother was probably thinking when she checked DNR. I started to think if I was in her position in a hospital bed with tubes coming out of her arms and her nose, in constant pain, not around family and friends. Alone with machines keeping her alive. For what the next day to wake up in the same place not having strength to get up and go to the bathroom or go outside and breath some fresh air. I thought a lot about how I would want to spend my final days, months, or years. Would I want to be in a hospital bed when I already know the end is inevitable?

I have always been optimistic but pessimistic or hoping for the best but planning for the worst kind of guy. My mom calls me a realist. I can tell when its time do stop and find another way to do something. When it comes down to it and you get the news that you have a terminal illness and you know how much time you have left with lots of treatment and how much time you have with no treatment. At one point we all have to face this whether it a loved one or yourself. Without treatment you have six months live. With treatment your life could be extended three to six months. What one would you choose? How do you want to spend it? Do you want to just extend your life? Do you want to be at home with family? What constitutes living?

Sara Monopoli was pregnant with first child when she found out that she was going to die. Her lung collapsed and her chest filled with fluid. The doctors tested the fluid to see if it was an infection, but it was non-small cell lung cancer. She had done nothing to have this happen. Never smoked or anything. Her cancer was advanced and spread to lymph nodes and the cancer was inoperable. There is no cure for lung cancer this far along. Sara tried chemo, new drugs, and had surgeries to drain the fluid around her lung (that didn’t work) so they put a permanent tube in her chest. She went home in between chemo cycles. She then came back to the hospital for and the tumors in her lung, chest and lymph nodes had grown a lot. She then tried another new drug that on average extended life by two months from year. She didn’t have the strength to walk down a hallway. And for what? Two extra months? A month or so after she started the new drug she had a CT scan that reviled that it didn’t work. The cancer had spread to both sides of her chest, to he liver, to the lining of her abdomen, to her spine. This part of life doesn’t make sense. Such a wonderful human that just had a kid and is now in this situation.  What now? Do they try something else or do they quit? They tried so many things and it still hadn’t worked. And at this rate the drugs that they are giving that are supposed to make her better are having side effects are making her weaker.

Atul Gawande tells this story of Sara and how her and her doctors are trying to keep her alive long enough, so her daughter can remember her. What would you do? I feel like modern medicine are so caught up in trying to keep the patient alive for as long as possible. Whether this is due to the fact the more the patient comes in the more money they will make, or they actually care deeply about the patient life and want to cure them I do not know. What I know is that I comes down to the fact of quality over quantity. Would I want to have a long life full of hospital bed being alone with machines at night or a shortened life being at home with my mom and dad and my sister and my dog and my friends. To me the most important things to me in order my health, my family, and my friends. If my health is gone I would want my family and friend to be there for me. That is quality. Being with friend and family. Quantity is not living. You are unable to move or speak. You could be eating though a feeding tube. You could be unconscious. You could have no idea to what is happening around you. And when you go you could have no loved ones around you. How do you see yourself dying when there is nothing else you or anyone one can do?

How do you tell someone that they are going to die? How do you ask them how do they want their final months or days to be? Does longevity of life matter more than the quality of life? What should medicine do when it can’t save your life? These are difficult questions to ask someone or ask yourself. Atul Gawande sheds some light on what doctors, patients and the patient’s families do when medicine can’t save your life. Gawande is a surgeon and a writer and in this article, he tells the stories of multiple people all from very different lives and different ages and different types of illnesses. The one thing that all these people have in common is that they all have is that they are all on the tail ends of there life. They all have some kind of terminal illness.

These people are all average people in the United States have kids, a spouse, a job, a house. I always been told that I am a very blunt and brutally honest person or that I have no filter. And I try to be. I hate when people beat around the bush to tell me a problem with something that I am doing. I tell them just tell me I can take it. The one thing I don’t think don’t think I could take so bluntly is if someone told me I had three months to live. And I am a person that doesn’t show my emotions very well. I tend to hold them in till I’m alone it also takes a lot to change my mood as well. When reading this article every time a question was brought up to one of these people of: How do you want to go? It made me think that if I was in the shoes of those people and how would I want to go. My immediate reaction was I want to stay alive as long as possible. As I indulged myself in the text I changed my mind from wanting quantity or quality of life. Did I really want to be in a hospital bed when I die or at home surrounded by family and friends? I would rather live a shorter life if I can be doing what I want to do than a long life in misery and pain.

INFORMAL ESSAY:

As I gazed upon my picture of my face that some people called cute, handsome, and what my Athletic Director in high school called ugly I noticed a lot of my flaws that I notice but no one else notices. From the small acne to smalls scars and large scars. I learned when I really concentrate on the picture I noticed these things and I want to draw them but I’m not that good of artist. When I looked the picture and I pay attention to those little flaws that all I can really see. I can see now how the fact of body image and of self-confidence is a problem. Then when I look at the self-portrait I pay attention to the little things that don’t make it look like me. Like how I forgot the ears and my face shape is weird and I did my best to pay attention to the little details and forget about the big picture. Like I hadn’t shaved in a few days and I had a little scruff, so I put that in. I have high expectations of myself in everything that I do I know that I’m no artist, but I still want to set the expectation high and shoot for that goal. The relationship between the writing and paying attention is that when you don’t pay attention you tend to forget about the details and leave them out. If you have expectations to include details and set a goal for including details, you usually can achieve that goal. They only thing that those minute details can ruin is the big picture. I play football and it’s a game of inches and the details matter. And paying attention to those details is key in success in football. Our coach every day tells us to “Lock it the **** in.” The expectation is that we are paying attention and focusing on the little details and the little mistakes with technique or alignment when we are watching film and then learning from them, so then in a game we can fix them and we can be successful.

NOTES:

I noticed in the picture I drew of myself that I don’t have ears but in the pictures that I noticed that the very fine features like the scar on above my eye and the small scars from the horrible acne from middle school aren’t there. My face shape is also not my exact face mainly because I didn’t want to make it exactly it was a good caricature, but I am no artist by any means. Something that went right was me drawing the hat I was wearing and the lettering that was kind of pretty hard. Another thing that went right was the eyes and the eyebrows I had remember back to my 7^th grade art class to make sure they actually looked like eyes. I successfully transformed this perception of my face into an image by the hat that I was wearing. Something that went wrong was that forgot my ears and my face shape is wonky. I did not noticed the fact that I had no ears… I felt like this was a weird thing to be doing in an English class… especially in a college English class. I felt awkward when I was done because I was confused, and it just felt weird that we would be doing this in a college English class. If I told my parents that I did a self-portrait in English they would say we are not paying thousands of dollars for you to become an art major.

Conference One Report & Reflection

During my meeting we talked about how I was always present in class and that there are some things I need to work on and some things I am doing well in. I need to work on the Integrating Ideas and Academic Conversations portions. I had a lot of OKs and a few Not Yets. I struggled a bit with introducing the quote and my purpose was not always clear on what I was trying to introduce. I tried hard when writing essays on using signal phrases but in some places, I used it awkwardly. On the voice markers I just need to used voice markers more and I can do this by using the template. On the Reading Process I just need to ask more questions and write more about why I thought something was surprising or what made me question something. My writing process needs work, I need work on using introducing new implications or conclusions because I was reconsidering my thought process. On engagement I felt like that was my biggest asset because I was always in class and I am engaged. The only thing I need to work on is making sure I read and do all of the homework.

I have used the techniques of introducing the quote and then explaining the quote and then stating my thoughts about it in other classes. Like in my Environmental Issues class I needed to state quotes so I used the technique of introducing then summarizing and then giving my thoughts. I am always engaged and give a persistent effort in everything I do whether it’s in class or in sports mainly because I don’t like slackers. I feel most confident about learning from my failures. When I made a mistake in one of my early papers in English I fixed it then I was quick to fix when I made it again and now I don’t make that same mistake. I have a good understanding about the value of writing in my life because I will be writing for the rest of my life and I want and would rather be good at it than be bad