When Dying to Live Makes Dying Horrible

The New Yorker has an incredible article on its website today: Letting Go by Atul Gawande. Gawande tackles the question: What should medicine do when it can’t save your life?

The answer lies in a heartbreaking story Gawande tells of a young woman diagnosed with advanced lung cancer while 39 weeks pregnant. Her story illustrates the difficulty physicians have in communicating honestly about chances of survival and the struggle of families to accept the reality of a diagnosis.

It’s a must-read article (but schedule a good 30 minutes for it—it’s a long article) that provides incredible insights that will be helpful as you face your caree’s death and your own. (You’ll find the article here.)

Some interesting information from the article:

• A 2008 study, published by Coping with Cancer, showed that the family caregivers of terminally-ill patients were three times more likely to be diagnosed with major depression six months after the patients’ death if the patient received invasive treatments  (mechanical ventilator, electrical defibrillation, chest compressions, admission to intensive care). “Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure,” Gawande writes. “You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or ‘It’s O.K.’ or ‘I’m sorry’ or ‘I love you.’”

• Research shows that terminally-ill patients want to avoid suffering, be with family, have the touch of others, be mentally aware and not be a burden. “Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars,” Gawande says. “The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.”

• 25% of all Medicare spending is for the 5% of patients in their final year of life. Most is spent during the last months of life, without much benefit to the patient.

• In one study of 4,493 Medicare patients with either terminal cancer or congestive heart failure, hospice care actually extended life for some patients. “The lesson seems almost Zen: you live longer only when you stop trying to live longer,” Gawande says.

• Patients often opt to undergo treatments simply because that’s what their family members want.

Incredibly helpful information to remember because, as Gawande writes, “People die only once.” You want to get it right.

Related Articles

• Letting Go When We Worry We Should Hang On (caregiving.com)