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Atul Gawande: Letting Go - What should medicine do when it can’t save your life?

KavuRider

Turbo Monkey
Jan 30, 2006
2,567
3
CT
Letting Go
What should medicine do when it can’t save your life?
by Atul Gawande

http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?currentPage=all

I'd quote from it but the whole thing is so beautifully written, and an important message. I have seen the same tragedy played out, and it is my most sincere wish that I not die trached and PEGed, tubed and vented in an ICU as I have seen so many times.
Great article, thank you for posting.

I agree with you as well. It has to be difficult to work with patients like that.
 
i can think of numerous instances where i saw spry (well compensated) 80+ year olds show up for open heart surgery only to be discharged one month later "tubed" up to a long-term vent / subacute facility to die.

sometimes, just because we could doesn't mean we should.

powerful write-up
 

Pesqueeb

bicycle in airplane hangar
Feb 2, 2007
28,663
4,466
Riding the baggage carousel.
What an amazing read. Having been trached and PEGed once already on the "road to recovery" I'm absolutely positive that I don't want to go out like that. One of the lessons of my accident was that the wife and I both made sure that each other understood the final wishes of the other should either of us ever wind up in a vegetative or other similar state. We also committed our wishes to legal documents. Its a good idea for any one.
 

jimmydean

The Official Meat of Ridemonkey
Sep 10, 2001
29,942
2,747
Portland, OR
Excellent read.


I got to watch this when my father passed early this year. He was diagnosed with prostate cancer a month before their 50th wedding anniversary. Despite the diagnosis, we had a huge party and tried to carry on as if nothing had changed. He was treated with a variety of things before chemo, then came the chemo after other things failed.

Initially, he responded very well and looked great. After much swelling, and bloating, and all sorts of issues related to the previous treatments, the chemo was working. He had his color back, he wasn't bloated, and he was able to get around by himself on a daily basis.

A full year after the diagnosis, it looked like he had it beat. My folks visited with me in Ashland in October of last year. It was their first trip in 2 years (they used to come twice a year every year) and pops looked awesome. As they were leaving, I told my dad how great he looked and he said to me "Every day is a gift, don't ever forget that".

I didn't fully understand that until Valentines weekend when the chemo quit working and my dad crashed. I went to see him that weekend in the hospital and told him I would return the following weekend with the family. As I was leaving, he looked at me and said "I'm not in control of this anymore". I knew right then it was the last time I would talk to him.

The Thursday following his kidneys gave out. He was taken off all the machines and was given morphine to ease the pain. I left as soon as I got word, but didn't get to the hospital until 9am on Friday. He passed at 12:30 that day. I got to see him, but he was not responding, just breathing. My father, the most strong and powerful figure in my young life laid there so weak and helpless. I had a very hard time even being in the room that day seeing him like that.

But it was that experience that made me realize I didn't want to go out plugged into machines that keep an otherwise expired body alive. I am all for modern medicine, but there comes a time in your life when "you aren't in charge anymore" and it's time to let go.

The topic of modern battlefield medicine is brought up a lot with friends. Field treatment has gotten so advanced that people who would have normally died on the battlefield have been saved. But should all who can be saved in fact be saved? What sort of quality of life might someone have with the extensive injuries? Where do you draw the line?

<edit> Wow, that was a lot longer than anticipated.
 

$tinkle

Expert on blowing
Feb 12, 2003
14,591
5
sent this to my mom, as she's an ardent plug-puller. which makes sense, being someone who's terminally bitter.

why fight for diminishing returns on poor investment?
 

$tinkle

Expert on blowing
Feb 12, 2003
14,591
5
that's pretty funny, actually, considering she abandoned me as a baby


yeah, analyze *that*
 

rockofullr

confused
Jun 11, 2009
7,359
907
East Bay, Cali
Awesome read. My father is a doc who has worked with Hope Hospice for many years and after seeing the difference between hospital care and hospice care for terminal patients I know where I will be if I ever have to choose.
 

jimmydean

The Official Meat of Ridemonkey
Sep 10, 2001
29,942
2,747
Portland, OR
I'm still breastfeeding...but mom's cutting me off when I turn 35.
My ex-wife is a certified lactation tech and she says that your immune system will love you for it. Of course I'm sure you are in full dentures due to bottle mouth, but it just means you will always have straight, white teeth, the way god intended.