Letting Go
Hospice medical care for dying patients : The New Yorker
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ANNALS OF MEDICINE
LETTING GO
What should medicine do when it can't save your life? by Atul Gawande
AUGUST 2, 2010
Modern medicine is good at staving off death with aggressive interventions-—-and bad at knowing when to focus, instead, on improving the days that terminal patients have left.
• Ql ara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die. It O started with a cough and a pain in her back. Then a chest X-ray showed that her left lung had collapsed, and her chest was filled with fluid. A sample of the fluid was drawn off with a long needle and sent for testing. Instead of an infection, as everyone had expected, it was lung cancer, and it had already spread to the lining of her chest. Her pregnancy was thirty-nine weeks along, and the obstetrician who had ordered the test broke the news to her as she sat with her husband and her parents. The obstetrician didn't get into the prognosis—she would bring in an oncologist for • that—but Sara was stunned. Her mother, who had lost her best friend to lung cancer, began crying. The doctors wanted to start treatment right away, and that meant inducing labor to get the baby out. For the moment, though, Sara and her husband, Rich, sat by themselves on a quiet terrace off the labor floor. It was a warm .Monday in June, 2007. She took Rich's hands, and they tried to absorb what they had heard. Monopoli was thirty-four. She had never smoked, or lived with anyone who had. She exercised. She ate well. The diagnosis was bewildering. "This is going to be O.K.," Rich told her, "We're going to work through this. It's going to be hard, yes. But we'll figure
Hospice medical care for dying patients : The New Yorker
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Page 2 of 15
it out. We can find the right treatment" For the moment, though, they had a baby to think about. "So Sara and I looked at each other," Rich recalled, "and we
Page 1 of 15
ANNALS OF MEDICINE
LETTING GO
What should medicine do when it can't save your life? by Atul Gawande
AUGUST 2, 2010
Modern medicine is good at staving off death with aggressive interventions-—-and bad at knowing when to focus, instead, on improving the days that terminal patients have left.
• Ql ara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die. It O started with a cough and a pain in her back. Then a chest X-ray showed that her left lung had collapsed, and her chest was filled with fluid. A sample of the fluid was drawn off with a long needle and sent for testing. Instead of an infection, as everyone had expected, it was lung cancer, and it had already spread to the lining of her chest. Her pregnancy was thirty-nine weeks along, and the obstetrician who had ordered the test broke the news to her as she sat with her husband and her parents. The obstetrician didn't get into the prognosis—she would bring in an oncologist for • that—but Sara was stunned. Her mother, who had lost her best friend to lung cancer, began crying. The doctors wanted to start treatment right away, and that meant inducing labor to get the baby out. For the moment, though, Sara and her husband, Rich, sat by themselves on a quiet terrace off the labor floor. It was a warm .Monday in June, 2007. She took Rich's hands, and they tried to absorb what they had heard. Monopoli was thirty-four. She had never smoked, or lived with anyone who had. She exercised. She ate well. The diagnosis was bewildering. "This is going to be O.K.," Rich told her, "We're going to work through this. It's going to be hard, yes. But we'll figure
Hospice medical care for dying patients : The New Yorker
'
Page 2 of 15
it out. We can find the right treatment" For the moment, though, they had a baby to think about. "So Sara and I looked at each other," Rich recalled, "and we