HW 10/24

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.