Letting Go, Reaction Paper Example

The case described in the article (Gawande, 2010) reflects on the role of doctors, medication, and the new ways of death. “Ars morendi” (the art of dying) has historically been a very popular topic. People accepted death as unavoidable. Today, they are given (often false) hopes to fight it, and they enter a battle that resembles the one Don Quixote had with the windmills.  Sara Thomas Monopoli is not ready to give up. She clings onto every single piece of hope he is given. However, it is important to note that caregivers and doctors have a great responsibility for her decision to carry on with invasive and aggressive treatment plans.

How Sara Died

In the end, after accepting death and letting go, Sara died peacefully. She must have been exhausted of all the treatments, medications, and finally gave up hope. She died after a long term battle with cancer and its complications. He was still hoping to get better, and wanted one of the drugs or therapies to work. They did not. The treatments did not extend her life, but reduced the quality of it. While she was anxious about the next treatment’s effectiveness and hoped that he would be finally treated, she got worse. She suffered more than she would have if she opted for hospice care. The author (Gawande, 2010) confirms that in some cases, hospice care extended patients’ life, while it did improve the quality of their everyday living. For Sara, the most important thing was to spend quality time with her young child and family. She was depraved of this, as she had to regularly visit the hospital for check-ups, chemotherapy, and other treatments. While she was able to have some conversations with her family about death and the education of her daughter, she never fully accepted the immense nature of death. She was constantly living in false hope. She is likely to have suffered more than she would have in hospice care. She was not given clear options about her treatment. She died after a long, exhausting battle, but finally she let it go.

What Doctors Did Right

Doctors’ duty is to make sure that they try and save the patient’s life. They understood how precious every moment spent with her daughter was for Sara. They felt pity and tried their best to help. They tried different drugs, therapies, intervention, treatment plans, operation, but failed to make the illness go away. While they knew the statistical rate of surviving similar conditions, they, too hoped that a new treatment would work. Sara’s family doctor, however, did more than any of the specialists. Morris had the conversation with the family about the impact of treatments on Sara’s body. He explained how the different drugs weakened her immune system, how they reduced her quality of life. Sara felt pain and discomfort, but did not want to tell doctors, because she did not want to stop treatment. She was desperate to find something that worked, and this desperation made her worse.

What Doctors Did Wrong

Doctors did not ask Sara about her preferences related to end-of-life treatment. They were not clear about the chances of prolonging her life. And certainly, Sara was not aware that she had close to zero percent chance for survival. As the author describes: “more than forty percent of oncologists report offering treatments that they believe are unlikely to work” (p. 8). While doctors cannot be sure about the effectiveness of the treatments available, they still feed the hope of patients. They just do not want to make them feel worse by shattering their last hope. Having a conversation about patients’ preferences, however, can reduce the cost of health care, as well as the pain caused to patients. The author also states that “people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish” (p. 10). While many people state that they do not want to be force-fed by machines, before they get ill, they change their mind after they face a terminal illness. Instead of allowing patients to face the facts, doctors “go along” with their decision, no matter what the consequence of it is.

What Other Options Sara Had

If I were in Sara’s place, I would have clearly asked about the chance of survival. If it was less than thirty percent, I would have opted for hospice care. Sara was never clearly offered this option, even though she had a very supportive family, and she could have spent more time with her young daughter that way. I would also have asked about the chances of the next treatment to work, and the side effects. In several cases, I have opted not to take a medication and deal with the symptoms, as I wanted to avoid side effects. In Sara’s case, one of the most important of these side effects was a weakened immune system. She could not see her daughter if she had the slightest sign of cold. This impacted her life in the last months. I would have accepted death, and made the most out of the time left. Just like Doctor Block’s father, I would have laid out the foundations to determine when to let go. I would never want to be fed by machines, washed, and for me, painless life and clear mind would have been a much better option than jumping from one treatment to the next and being stressed over and over again about the ineffectiveness of the drugs.

Reflection

Overall, the article made me think about the real role of medication and doctors. The main takeaway statement of the article for me is: “We’ve created a multimillion-dollar edifice for dispensing the medical equivalent of lottery tickets”. Patients are made to fight a battle that they cannot possibly win, and this costs the health care of the countries billions of dollars. Most of the treatments reduce patients’ quality of life. At the same time, doctors are afraid of having the important conversations with patients about end-of-life treatment options. Just like the author, most oncologists are hoping that a treatment would work. They do not tell patients about their chances. In order to allow patients to make informed decisions, they need to be helped to face the facts, understand the risks and side effects of different treatment options. While it is true that doctors do not get paid for having conversations with patients about their options, it is important that somebody does. Qualified, experienced hospice staff, nurses, or specialist carers might undertake this task. This would make patients’ options clearer, and they could enjoy the last months of their lives in dignity.

Bibliography

Gawande, R. “Letting Go – What should medicine do when it can’t save your life?” The New Yorker – Annals of Medicine. August 17, 2010