Life and Death
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.
- Do you want to be resuscitated if your heart stops?
- Do you want aggressive treatments such as intubation and mechanical ventilation?
- Do you want antibiotics?
- 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.