THE NEW YORKER. ANNALS OF MEDICINE. LETTING GO. What should medicine do uhen it can’t suve pour life? by Atul Gawande. AUGUST *. >> wait. Gawande begins “Letting Go” with the story of Sara Thomas Monopoli, 39 weeks pregnant with her first child “when her doctors learned that. I want to draw people’s attention to a fantastic new piece in the New Yorker by Atul Gawande titled, “Letting Go: What should medicine do when.

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Letting Go: What Should Medicine Do When It Can’t Save Your Life?

You and I may think we have given the issue of end-of-life care a great deal of thought—and we have. My husband and I expecting our first baby in October are having a will written up with a lawyer.

It is only for PAIN. A doctor cannot force people to talk about death. I told Sara that the thyroid cancer was slow-growing and treatable. In the live exchange at the New Yorker site a few days after the article, Gawande wrote: Rather, as Gunderson has shown, they can serve as a valuable jumping off point to initiate a discussion that is difficult for providers, patients, and families.

I assume patients with a terminal illness would have different attitudes towards palliative care depending on their state of mind.

Atul Gawande: “Letting Go: What Should Medicine Do When It Can’t Save Your Life?”

The whole point of the questions — and from what I read in the article it sounds like they are not a questionnaire but rather lettiny guideline for providers to initiate the discussion of life support lettung — is that that gawanfe is on the chart BEFORE the patient faces serious illness. The doctors induced labor, and Sara and Rich decided that, for one day, they would enjoy the birth of their first child.

I have taken the Hospice training and have been intimately involved in four deaths. A lot has been said about the high cost of end of life care, and a lot of emphasis has been placed on the cost savings that could result in forgoing that care. My dad doesn’t want to talk about his illness.


Chris- Good to hear from you. He went to a medical library when he got the diagnosis and pulled out the latest scientific articles on the disease. Logically, your argument makes sense, but politically it would never fly.

When there is no way of knowing exactly how long our skeins will run—and when we imagine ourselves to have much more time than we do—our every impulse is to fight, to die with chemo in our veins or a tube in our throats or fresh sutures in our flesh. People keep complaining about it, but then they take their kids to Disney World! She had wavy brown hair, like her mom, and she was perfectly healthy. Many of these patients will survive, and go home.

Atul Gawande New Yorker Article “Letting Go”

Gawande offers us useful insights on the highly complex and emotionally charged topic of end-of-life. I have had this conversation with more than one Park Avenue specialist.

Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers. This works well at Gunderson partly because Gunderson is a partly closed system — as a major provider in a small city, a large number of the patients who arrive at the hospital in distress are patients who have been seen by the system before.

For these patients, too, hospice enrollment jumped to seventy per cent, and their use of hospital services dropped sharply.

Over-all costs fell by almost a quarter. July 28, at 8: That is why the early versions of the Federal Health Care Plan contained a provision for holding exactly the same sort of discussion that Gunderson does. In some places, we may have to wait for a generation of doctors to retire.

For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light. Since, as the Gawande article stresses, discussions involving planning for the death of patients are well outside the comfort zone for most doctors as well as outside their training experience, many simply choose to ignore the notion, or as Gawande admits about himself, botch and chicken out of discussions.


But it seems important to note for this community. A friend lettig mine died last year after living with a diagnosis of leukemia for a year and a half.

They also talked about starting dialysis, with the option to go off. These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. Once, I asked her and her husband about our initial conversations. And, the better the doctors knew their patients, the more likely they were to err.

Finally, I definitely agree that the Gunderson model shows that end-of-life care CAN be handeled in a compassionate and rational way, giving the patient a chance to share in the decison-making. These subjects were Medicare enrollees who were participants in the Health and Retirement Study.

“Letting go,” and why it’s so hard to do: Atul Gawande explores the challenges of end-of-life care

As to why this is not applied more widely: Often, patients who undergo palliative or hospice care live longer than those who stay in the hospital or ICU. Factors considered important at the end of life by patients, family, physicians, and other care gzwande. I would very much like to know the list of items Susan Block covers in her talking to dying people and their families. In his essay, Gould wrote: The ho seems almost Zen: Their approach should be widely copied and regional differences in end of life medical outcomes should be widely publicized.

In his article Dr. They do get the conversation started, however. PDF of Total Patient She had told her family on several occasions that she did not want to die in the hospital. Technology sustains our organs until we are well past eltting point of awareness and coherence.