Unit 9: “Letting Go” Reading Response

Get the discussion on this article started by posting your reading response here. Please remember that you will need to post your response and then read other students’ responses and post  a reply.

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In “Letting Go,”  Sara Thomas Monopoli and her family fight so hard against her incurable cancer, they aren’t able to make conscious decisions about the end of her life. It’s a terribly sad story, and all too common in modern medicine.  Many of these examples beg the question of how and if we (as a government, society, family, etc) should honor decisions about death, and the right to a dignified and peaceful goodbye. In your response, reflect on how you might react, should one of your own family members face this terrible battle.  What do you know after reading this piece that might change how you approach the situation?  How has advancing science and technology actually blinded us to the reality of these dire situations?

Write your response as a comment to this page.

43 Replies to “Unit 9: “Letting Go” Reading Response”

  1. This article was well written with many good observations on a tough subject that many people don’t want to consider or plan for. Although we may not like thinking about death, it will come to all our family members and ourselves. Like many other experienced (that’s pronounced “older”) people, I don’t have to reflect on how I might react. I know. My aunt had a similar situation as many people in the article. With terminal throat cancer, the choice was between a better quality of life without chemo vs maybe a month or two more time with Chemo. She decided to pass on the chemo and enjoy the time she had vs being so sick she couldn’t make use of the time she had left. She decided on hospice care and was at home with her husband and family until the end. When you’re young you think everyone will live forever. As we get older and look back at our lives we know better. Reading this article only confirms my positions on these end of life questions and decisions.

    I agree that modern medicine can do a great job at extending the dying process. It can be drawn out for weeks, months or even longer. It’s easy for people to think everyone can be returned to good health; everything is fixable. This at times blinds us to the fact that we will all die and medical science can’t change that. At what cost do you gain more time? This question is not only about monetary issues but it is also about quality of life. We each much decide for ourselves how to answer that question. Living Wills and Do Not Resuscitate (DNR) orders are becoming common place and give instructions for our wishes. I think this shows more people are choosing quality of life over time. These wishes and orders should always be followed. Although death is a sad time for those left behind, many people choose to face it with strength, resolve and dignity.

    • I particularly liked your emphasis on quality over quantity. In fact I would extent that argument beyond terminal illness to life itself, it is always best to “die on your feet than to live on your knees”. Nevertheless, we must also realize the fact that the views on situations such as terminal illnesses are completely different depending on what position we are in. One might think simple to decide forgoing treatment to have a more pleasant end of life, it is our lives after all right? But what about say our family members and other loved ones? Would they assume and accept this decision as easily, even knowing it is a willful decision? The dilemma with a decision of this nature boils down to all the factors, including other people, that need to be taken into consideration.

    • Hello Jack,

      I agree with you that unfortunately, death is inevitable. And each death is a heart-wrenching experience, and with that is a new grief process that has to happen. I appreciate your example of your aunt, and if I were in a similar situation I would choose my short quality of life, over getting treatment and being extremely ill, unable to accomplish anything, and ultimately dying. When you come to this stage in life, or someone around you is passing away, although it is easy to ask yourself all of those questions, it is better to let them know you love them and it is okay if they let go. Because as expressed by Gawande in this essay, “Rich knelt down weeping besides Sara and whispered in her ear. “It’s okay to let go,” he said. “You don’t have to fight anymore. I will see you soon.” Later that morning her breathing changed, slowing. At 9:45 A.M., Rich said, “Sara just kind of startled. She let a long breath out. Then just stopped.”” (p. 156) Which it is an unfortunate fact, but people usually hold on for the sake of their loved ones. And modern medicine, as you stated, can be beneficial and prolong life. And as they advance in it, it may become a more stable and reliable option. I appreciated reading your opinion and perspective on this essay.

      Sincerely,

      Cheyenne Rodriguez

    • Death is inevitable and I agree that the medical field has extended death. I think this is hurting our society because people are paying enormous sums of money to not die. because of this the industry has made this into a business praying in the fear of death. I believe this is wrong and that people should let nature tack its course.

  2. “Letting Go” is indeed a sad article that presents the troublesome subject of dealing with terminal illness which integrates many complex factors involving human nature, moral views, and personal affection. These multiple factors involved in the consideration of a following course of action are in fact the reason a resolution is so difficult to find. Personal affection will often drive people to push themselves and their loved ones to fight for life against any obstacle or any disease regardless of how improbable a recovery might be. Moral values of selflessness and empathy will on the other hand make us consider what the optimal path for our loved one might be within a reasonable assessment of his or her particular situation. Furthermore, consideration of human nature and the nature of life itself might lead us to the realization that death is just another aspect of life, and that it must be accepted and processed in a natural way regardless of the sadness a loved one’s departure might cause.

    This is personally a subject I try and fortunately have been able to avoid as I haven’t had to deal much with death in my life. However I have always found myself giving more weight to the third factor I presented above involving the understanding of death as another stage of life. I am personally not very fond of death, and would really hate to see a close friend or family member die. However, I realize that whether we like it or not death is among us, and it is not going anywhere.
    Before reading this article I guess my course of action in the event of the illness of a loved one would have been the same as most people are reported to follow: encourage a fight for life for as long as a potential cure treatment is available. Now however, after realizing that, since so many procedures and alternatives are available, knowing when to stop treatment can be entirely subjective, I see this approach is not really applicable to our times. After reading the article I am realizing one of the best solutions might also be one of the simplest: discuss the ill’s priorities and how they would like to face a potential complication, a sort of “hope for the best and be ready for the worst” conversation.

    Having control over another person’s life, especially a loved one, is an extremely delicate ground in terms of moral views and can cause chaos in our minds. The optimal path to take in these hard situations might be just that taken by Dr. Susan Block when caring for her ill father: the best decision is to not make that decision (150-151).

    • I agree with you that a “hope for the best and be ready for the worst conversation.” is the best way to go. Even if we do not like it, the worst will always happen. Being prepared and clear on a loved ones instructions helps minimize those moral questions and choices. It is after all their decision and not ours. Things really get complicated when our loved one is not of sound mind. Without having directions from the person, we can only do our best. This type of situation only reinforces the “hope for the best and be ready for the worst conversation.”

      • I agree with your idea that personal affection is typically what drives us to encourage our loved ones to seek treatment and fight the illness, and after reading this article I strongly believe these emotions need to be put aside for the benefit of the individual with the illness. The higher quality of life that is made when “the decision is to not make that decision” is what would be better for the individual in the end and being aware of this is crucial.

  3. I enjoyed this essay and the perspective Gawande took while writing it. I appreciated the story about Sarah it started with, and the examples Gawande provided, but also tied in Sarah’s story back with what was talked about. Death is a heart-wrenching feeling, and a subject avoided by many people. I have had many people die in my life, although none were ever from diseases or cancer, but it never gets any easier to deal with. Because each person serves a different purpose and part in your life, so the grief is never the same, as well with the ways you cope with the grief. With diseases such as cancer, I think it makes it much more difficult for the patient and people around, because they know death is coming, but do not want to accept it. As Gawande stated, “The diagnosis was bewildering. “This is going to be okay,” Rich told her. “We’re going to work through this. It’s going to be hard, yes. But we’ll figure it out. We can find the right treatment.”” (p. 127) This proves that it is extremely difficult for people to let go and accept the facts, because they do not think about the pain or suffering the patient will endure, while usually passing away ultimately and unfortunately. Modern medicine has come a long way in prolonging life for some patients, but it is not the quality of life they were living before, and it usually has a time limit. Gawande points out something I have noticed about ill people, that I find ironic, “The lesson seems almost Zen: you live longer only when you stop trying to live longer.” (p. 136) As unfortunate as it is, most people live longer and more satisfied until they pass, once they accept death, and are fighting and draining their body any longer. Also addressed in this essay, most patients hold on for the sake of other people, until their loved ones let them know it is okay to let go. And even though we are human and it is a heart-wrenching feeling, you have to be unselfish and think about the person in pain, and what is most beneficial for them. Overall, this was a really great read that started a lot of thought in my mind, and something I could easily relate to and read.

    • Hi Cheyenne,
      I am sorry to hear about the losses in your life. I totally agree with you that death is hard to talk about aspecially with someone who is terminally ill. I am always impressed with how hopeful people are and how they don’t want to give up on life. You brought that up nicely when you quoted Rich. My beyond favorite part of your response is when you talk about it being OK to let go. Sometimes in our society we push people too hard to not give up and persevere but in some cases when letting go will give someone a better quality to the end of their life it is probably the best to let go.
      Great ideas! Thanks!

  4. For a variety of reasons, I have been intimately exposed to palliative care and end-of-life decision making most of my life. I distinctly remember making a specific case for submission to hospice care to my fourth-grade teacher. The decision as to whether to continue to fight a “terminal” illness or to focus on quality-of-life is one that cannot be addressed with blanket ideas. Too many variables surround any medical concern. For instance, my experience with an anaplastic astrocytoma would not be exactly the same as any other patient’s; perhaps mine was found a few weeks earlier or later, perhaps there are other health concerns that I have that another patient does not, and on it goes. My own grandfather was diagnosed with abdominal mesothelioma in 2004, the same cancer that was mentioned in the text as afflicting Stephen Jay Gould. Despite that diagnosis and his refusal to be treated for it, the old bastard continues to live — and smoke — as of this writing. My point here is that it is unreasonable to attempt to put a “one size fits all” solution onto how end-of-life decisions are handled or even how they are discussed.
    If one were to attempt a comprehensive solution, however, ideally it would be market-based. Those who have both the desire and the funds to follow a course of treatment should be free to do so. In the absence of a truly free market, however, where we have medical decisions determined by government agencies and insurance companies aligned with employers, the decision on a method of care should be an economic one: which course of treatment provides the best likelihood of a positive return on investment for the company (in the case of insurance) or for society (in the case of a government entity)? The proven efficacy of the proposed treatment must be balanced with the continuing monetary value the continuation of the life in question can provide. A thirty-four year-old, like Monopoli, would obviously possess a higher societal monetary value than an eighty-four year old with the same diagnosis, due to Monopoli’s potential future production in the workforce. By making decision based in quantifiable economic terms, society can alleviate some of the unease and discomfort to those nearing the end of their lives.

    • You have an interesting argument with your statement “The proven efficacy of the proposed treatment must be balanced with the continuing monetary value the continuation of the life in question can provide.” I agree that these issues may be taken into account when making decisions but I hardly think this type of system would be ideal. I can envision someone at an HMO or government office deciding if you or your relative “deserves” care based solely on a grid of cost analysis. I agree with your statements that a “one size fits all” solution doesn’t work. We each need to have the right to make our own decisions and other people should respect those choices. Even if that choice is to stick our head in the sand and not make a decision.

    • The lack of government regulation in the healthcare industry is why these horrific situations exist in the first place. How are insurance companies not a part of the market? As the essay stated, there were provisions in the ACA that would provide funding to help individuals, who can hardly be asked to make decisions based on their monetary worth, deal with such issues. That part was removed to help it pass because the right wouldn’t accept “death panels”.

      Comparing the market worth of a young person and an old one is some mighty cold thinking. It actually disturbs me considerably and makes me grateful that there are government organizations who can protect me from such inhumane ideology.

      Additionally, an 84 year old has actual worth acquired over a lifetime in knowledge and experience, perhaps specialization in a certain field and almost definitely in net worth. Younger people have less economic worth because they have not had the time to develop their skills or amass much income. Their “potential” is irrelevant to economic growth because economics doesn’t work on potential, it works on actual numbers of things that already exist.

  5. I’ve had this conversation with my family and I have told others that I do no ever wish to be kept alive with machines, unless they’re used after a sudden traumatic accident or similar circumstance. Oregon allows patients to choose to end their lives if they face terminal illness. The fact that such actions remain a controversy is beyond my understanding. Why do we force people to suffer slow, agonizing death. I would much rather face death with the assurance I must suffer while I do so.

    I would respect my family’s wishes and know them already. Death is a certainty, we can’t shy away from it.

    Medical science is capable of doing extraordinary things to keep our organs going. But just because we can does not mean we should. I found it strange in the reading that the author seems baffled as to how increasing hospice care while also allowing conventional treatments would have the effect that it did. It seems very obvious to me that caring first for the comfort of patients is always going to yield a positive result.

    Medicine should not be a business, I suspect this problem has less to do with the advances in medicine creating life where it may or may not belong than it has to do with insurance companies and a lack of regulation in the medical industry. Nurses are unable to provide palliative care in a meaningful, useful way with the volume demands places on health professionals. When you treat people like numbers, and their treatment is dependent on numbers, people will always suffer.

    • Your response is spot on. It seems very obvious to me as well why the number increased through Aetna’s experiment. The patients comfort should always be priority in my opinion especially for terminally ill patients. Unless it is a patients wish to be experimented on and fight until all resources are exhausted. Then with a terminal diagnosis should come hospice care and a more comforting approach. Your correct “Medicine should not be a business”.

    • I think it’s important to have this conversation with your family, so good for you for already having done that. I think we can all agree that we can’t shy away from death, as much as we try to convince ourselves otherwise. I completely agree that we can’t always take extreme measures to save someone’s life simply because we can. There needs to be more to it than that. A dialogue between doctors, patients, and their loved ones about end of life care is so important. The patient needs to consider and specify what it is they want and the doctor needs to be ready and willing to have that discussion.

      Nice response!
      -Sabrina

    • Medicine has to be a business; one cannot create a right for others to enjoy out of the use of someone else’s labor in an ostensibly free society. If health care is provided to someone without cost or below market price, other individuals must be forced to give up the spoil of their personal labor to cover the value of the goods and services used to provide said care. Collectivism cannot work without forced redistribution. Stealing from Paul to pay for Peter’s hernia operation is not a moral alternative to having Peter pay for the best care he can personally afford.

      The practice of medicine is already one of the most regulated professions in the world. Further restrictions on the practice of medicine would serve to reduce advances in medicine, rather than improve the quality of care. For a current example, the cost and length of time associated with the FDA new drug approval process prevents known treatments for diseases affecting a small number of people sometimes prevents the company that develops the drug from bringing those beneficial drugs to the public.

      The problem with palliative care, as addressed in the text, is that many terminal patients do not opt to take advantage of it. It is not a matter of numbers in the sense of some unnamed entity making more money for a lack of palliative care, it is simply a matter of people disbelieving the reality of their situation and thinking that they can “beat” their ailment. Sure, nurses may be overworked. However, the work volume of nurses is not related, in a tangible way to the lack of palliative care; if nurses were taken out of the ICU, it does not follow that they would then choose to work in hospice nor does it follow that taking such action would increase the demand for hospice services.

  6. This article, “Letting Go” was a very well written emotional piece. I enjoyed it so much I read it over and over again. It struck a personal cord for me because I was close by my Grandfather’s side throughout his treatment of a malignant Glioblastoma brain tumor. It was an experience that I hold close, and reflect upon often. I witnessed firsthand the struggles that a terminally ill patient faces. When even with open communication, they feel a sense of pressure from their loved ones and doctors to fight off this inevitably terminal illness, by every means possible.

    My Grandfather went through multiple rounds of chemotherapy, radiation and surgeries. The chemotherapy made him so weak and frail that he could not do anything he enjoyed. He became so disoriented and weak that that at one point he fell and broke his hip. So at that point, not only was he battling a brain tumor, he then had to go through more surgeries, and rehabilitation for his hip that he would never fully heal from. He had no sense of taste, or smell, and most of the time he was too sick to eat. He was someone who enjoyed being outside, Mr. Fix it. He absolutely hated to be cooped up indoors looking out at his garden that he no longer had any control over. He died two years after diagnosis, and he was for the most part, physically miserable his last years on earth.

    The part of the article where Author Atul Gawande writes “The simple view is that medicine exists to fight death and disease, and that is, of course, it’s most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.” This paragraph really emphasizes quality of life over fighting an unbalanced battle. It perfectly states my feelings on what my Grandfather went through. I never want to see anyone go through the suffering I witnessed him go through. Especially fighting a disease that has a zero present survival rate. I would have so much rather have seen him embrace and enjoy his last few years on earth.

    Hospice programs are brilliant and it was interesting reading about Aetna’s findings from their conducted experiment. In all the situations that I have witnessed hospice care, it has been heartwarming. With my Grandfather particularly, we wanted to be the primary care takers in his last few weeks. He was provided everything he needed to be comfortable at home and we were provided everything needed to care for him. The nurses that came by to check in, would go above and beyond normal duties. They would give him foot rubs, bring him cookies and genuinely cared for him. They wanted him to have exactly what he wanted in the end. I would not say the same for the medical doctors that were involved along the way. Over all, this experience has made me a little more prepared for any similar future situation that may arise. I understand now how important it is to turn this terrible fate into a fulfilling end of life experience. Rather than a tortuous, fight to the bitter end one.

  7. If any of my relatives were battling with cancer or other terminal disease my priority would be to ensure that my relatives will is respected. I would be fine with whatever choice my relative selects. Whether choosing chemotherapy treatment, experimental treatments, juicing, cannabis oil or no treatment. I think it would be a good help getting grief counseling or general counseling. Additionally, I would search for information about the disease and if necessary recommend a support group to my other relatives. Often, people need help learning coping skills to handle difficult situations. Also, for some, talk alone is enough to cope. I would like to make sure that my ill relative and other close family members have at least information about the illness, how to help and how to cope. Knowing what to expect helps normalize the situation.
    This reading helped me understand some of the difficulties that people and families face when learning how to manage life with a chronic illness or a terminal disease. Unfortunately, choosing a treatment will not guarantee a cure. Not choosing any treatment is like accepting to die from the disease. Some people and relatives may see it as giving up. It seems like choosing chemotherapy or experimental drugs is a gamble. Chemotherapy debilitates the body, and for some it would only slow down the inevitable. I never knew the difficult choice people with cancer have to make. Comparing and contrasting the potential risks and benefits of getting medical treatment, If I had terminal cancer I would prefer to stay at home with my family, consume cannabis oil and try juicing. I would not set up any expectations about these home remedies. Also, I would continue to care for myself to stay as healthy as I can. I would eliminate all carcinogenic foods and drinks from my diet. I would spend quality time with my family and travel if I can. Additionally, if I were suffering a terminal illness, I would work on accepting my situation, everybody dies.
    The truth is that science and technology, so far, are good tools at slowing down death in people with terminal diseases. However, slowing down death does not guarantee a happier, and dignified death. In my opinion, people may feel more inclined to choose treatment because longevity is a cultural value here in the United States. Also, many people are afraid to die and depart from their loved ones. People in these situations need to be presented with options, and examples. If people are told what to expect, they can make an informed choice. Possibly people with terminal illnesses and their families choose medical treatments hoping to somehow get cured and resume their lives. Paradoxically, by offering hope to the terminally ill, technology and science are blinding people.

    • I agree science and technologies may help slow death, but it cannot prevent the inevitable. It sounds like you would want to make healthy decisions to improve your quality of life. I would probably opt to enjoy all I could and also travel.

      • Yes, I would totally prefer to improve the quality of my life rather than taking a risk at getting sicker. I like technology and science. However, I was shocked to learn from that the latest advances in medicine are not as beneficial to people as I thought.

  8. If myself or anyone close to me were faced with terminal illness, I would want to have a clear conversation, deeply discussing end of life care. This article definitely stresses the necessity for communication when it comes to making decisions about how to approach the inevitability of death. When faced with such a monumental decision, a strong support system is the best thing you can have. Being able to talk through something like that helps put our minds at ease. Having a plan, as morbid as it might seem, can help put yours and your family’s mind at ease.

    As I read, I thought about the whole idea of assisted suicide. While reading this article, I’ve been in the state of Oregon (where the Death with Dignity act originated) and it seems like everybody here knows somebody affected by it. People are obviously using the service, and I think that having such a thing available when facing terminal illness is a good thing. I’m glad to know that it exists, and I think it should certainly exist in more states than it currently does. In a documentary I watched awhile back called “How to Die in Oregon”, they follow the lives of several family’s with members who are seriously considering assisted suicide. It’s pretty sad, but also really eye opening and I highly recommend watching it.

    This article was very well written and respectful of those described, who were experiencing terminal illness. Death can be a sensitive subject, especially when it involves you or someone you care about. Gawande handles the topic really well throughout the piece by saying it like it is regardless of personal bias, and revealing inner struggles of both doctors and patients. Overall, I enjoyed reading this style of writing, and was really interested in the topic.

    • Having the discussion with ones family member can be hard. My family and I had to have the talk with my grandmother, and though it was tough she knew every detail, from where she wanted her final days, the speaker at the funeral, along with all other arrangements. The most important thing was she was surrounded by love. This article also made my think of assisted suicide. I think that decision would be hard to make. Its one thing to stop fighting the inevitable, but another to walk away from life.

  9. After reading this piece I realized that the quality of life of the patient should be prioritized over the ferocity with which the disease is battled. With certain diseases, the survival rate is so low that the devastation of the treatment could outweigh the benefits of living a good life before the disease ultimately takes control of the body. In my experience, a family member of mine who had cancer underwent several rounds of chemotherapy and was absolutely miserable. He could hardly move during our visits and through the aches and pains, constant vomiting, and endless fatigue, he wanted his life to end. The way in which he was living was not the way he wanted to live, and with the 15% chance of survival, the chances were not great enough for him to feel justified in living through such pain and suffering each day. He was a musician and an athlete, and wanted nothing more than to play his guitar and play a one on one game of basketball.

    This made me change the way I would approach the situation because knowing the last few months of my life would be spent miserably instead of doing the things I love and being with those who were close to me would not justify how I was living. Accepting the disease and living the way I wanted would be more meaningful to me than spending my time in a hospital, unaccepting of my illness. I believe I would be happier accepting my fate than I would be fighting it. I believe that the advancement of medicine and technology has blinded us in the sense that it has made the cure or treatment for serious illness a palpable reality. There is a chance at prolonging the life of a patient with serious illness diagnosis, but that does not necessarily mean it is a fighting chance. Our strong sense of the fight for survival can mask everything else, especially when there is a chance at survival. However, looking towards what will make us the happiest in the end, and ultimately accepting the reality that there is a larger chance of dying than surviving is what will maintain the highest quality of life prior to death due to the illness.

    • I agree with your statements. I have also watched a family member go through a number of treatments, that left them weaker. In the fight for survival, so many fight to hold on to life, without realizing they are letting what little time they had pass them by.

    • I completely agree with you: “The quality of life of the patient should be prioritized over the ferocity with which the disease is battled. With certain diseases, the survival rate is so low that the devastation of the treatment could outweigh the benefits of living a good life before the disease ultimately takes control of the body.” I wonder if the doctors persuade the patients to undergo treatment or if the patients do it because they feel is their only choice. Like you, I would also prefer to do the things I love and be happy rather than to be in a hospital.

    • Elizabeth, I really appreciated how your put yourselves in the shoes of someone fighting a terminal illness. I also would not be able to justify my quality of life. I think that this outlook should be applied to those who are suffering with no chance of recovery. It is hard to remove yourself from the situation emotionally, but I think that the patient would benefit from that type of consideration. Thanks for sharing!

  10. In “Letting Go,” by Atul Gawande, we learn about Sara Thomas Monopoli. Sara was diagnosed with lung cancer 39 weeks into her first pregnancy. Sara was able to deliver a healthy daughter and began her first round of treatment. This would be the first of many treatments that Sara would try, but none of them did anything to stop the spread of the cancer. Sara progressively became worse, but that did not stop her or her family from continuing to seek different treatment options, some still in the experimental phase. She would eventually succumb to her illness and passed inside the hospital. In the end, the hospital was not where Sara wanted to be, but she did not learn how to achieve this before her passing.

    I’ve been in this situation twice in my lifetime. The first time I experienced this was with my grandfather and the second with my grandmother. When my grandfather, who was battling cancer along with high blood pressure and Alzheimer’s, became ill, the family did all they could. We first moved him to a nursing facility so he could receive around the clock care, but he still became worse. Eventually he stopped eating, and forgot who most of us were. The precious moment was that he never forgot my grandmother, and the two would often stare at each other in silence holding hands. The family continued with all kinds of changes to his medication, feeding tubes, and breathing equipment. He would often attempt to pull this equipment out. He ended up passing in the hospital. My grandmother also had a number of medical conditions, including cancer and diabetes. The morning things became bad she was up and moving around with no problems, she experienced breathing problems and went in the hospital. After them having her bedridden for a number of days before releasing her, it became more difficult for her to move. She was out for 3 days before she went back in, diagnosed with pneumonia. Throughout it all, she expressed how she only wanted to be home. The doctors couldn’t control the fluid in her lungs but gave a medicine to help. They respected my grandmothers wishes and released her to hospice care. My family took turns looking after her and helping along with the nurses who came in daily. In the end she passed surrounded by family in the house she shared with my grandfather. Between the two I saw a number of differences. My grandmother left on her own terms, she did not fight against the inevitable, she was able to be close to friends and family, and kept her spirits up. She would often trick someone in the family into giving her Krispy Kreme doughnuts or coffee and would laugh about it after she would eat them before telling them she wasn’t supposed to have them. With my grandfather I felt our family wasn’t ready to let go. We did all we could, to the point we were merely saving the shell of the man, with tubes attempting to prolong his life.

    I knew from these two experiences how I would want the end. I would not want to delay the inevitable, but go out surrounded by the people who loved me, enjoying every minute I had left. This is not saying I would not put up the initial fight, but death comes for everyone. Modern medicine has people scrambling to hold on to life. Often these treatments lead to side effects which can lead to another issue. Knowing the end is coming is hard for anyone to face, but why go forward stuck in a bed tied to machines, when you could be making memories to at least have you happy in the end.

  11. This story was very emotional but also very thought provoking. It is very interesting to learn about how people handle the hardest decisions of their life. Although I have never personally gone through was Sara Thomas Monopoli or her family had to go through I have still thought about what I would do in her situation. I know that the meaning of life and the way people live life is different for every person, because of that I believe that each person should have the right to choose what is best for them. I would go as far as saying that once a person terns 18 they should fill out an emergency file that goes over wants for the end of their life. This would make it easier for that persons loved ones to follow the wishes of the patient and not have to guess what they would have wanted.

    Sara, got to decide what was best for her while she was not too sick to do so. If anything reading this piece just made me appreciate how truly hard it is to deal with making those decisions. In the past I have read about Britany Maynard who had brain cancer that was getting progressively worse. She chose to move to Oregan in order to take advantage of the “death with dignity law” which allows a person to be able to choose to receive assisted suicide. Britany wanted this because the cancer was causing her to forget how to speak and even who her family members was.

    In cases like Britany’s and even Sara’s I believe that people have the right to choose assisted suicide or any other way to die. Whether they want to spend millions trying different medications and studies or spend noting and die in their home. No matter what I think each person has the right to choose and should choose. I think that in some ways science and technology has blinded us. Sometimes more medication is not the answer, at some point difficult decisions might have to be made and there is not a magical pill that will make these hard decisions for you.

    • I really like the idea of a form filled out when you turn 18 that lays out any wishes you have regarding the inevitable. It gets you thinking about the topic and discussing it with your loved ones. I think if people originally filled it out when they turn 18 and then updated it every 2-5 years, it keeps the question in the back of everyones mind and if the worst happens, patients know how far they would want to go.

      • Dear Emily,
        I enjoyed reading your response as you describe that meaning of life and the way people live life is different for every person and therefor each person should have the right to decide what is best for them.
        The form you are suggesting is actually existing in Germany, it is called “Patientenverfuegung”. It is not exactly the same system as you describe it, but similar. In order to be taken of life support or feeding tube the patient must have this explicitly stated prior. The form is not mandatory, although like your idea to fill out a from at 18, and Rachel’s idea to update this form every 2-5 years.

        Alex

  12. This article really hit close to home for me, and it made me think hard about events that have recently unfolded in my life. I have to say, it is really hard question to bring up. It’s a question you don’t ever want to ask someone, especially not a loved one. But it is also a question that you need to know the answer to. It’s like Block said, “”If I had not had that conversation with him,” she told me, “my instinct would have been to let him go at that moment, because it just seemed so awful. And I would have beaten myself up. Did I let him go too soon?” Or she might have gone ahead and sent him to surgery, only to find– as occurred– that he survived only to go through what proved to be a year of “very horrible rehab” and disability. “I would have felt so guilty that I condemned him to that,” she said. “But there was no decision for me to make.” He had decided.”. While the conversation may seem painful for a little while, it is worth the pain you could face later in life tossing and turning thinking about if the right choices were made.
    I think that as medical technology advances, we need to try more and more to keep the patient’s quality of life in mind. I think that when terminally ill patients are diagnosed, they shouldn’t be given phone numbers to call if they have questions or feel like talking, they should be given a psychologist, someone who knows how to answer these tough questions that arise. They can help people initiate these difficult conversations and help keep the fear and suffering to a minimum. I think when the fear and pain is alleviated just a little bit, it can make all the difference in a patient’s life.

    • Dear Rachel,

      I really like how you bring up the point “quality of life”. This is something so important in my eyes. I also agree on your suggestions as you mention that patients should have the option to talk to psychologists. To have someone besides family members to talk to is in this stage of life essential in my eyes.

      Alex

  13. The article “Letting go” by Mary Roach absolutely touched me. Twenty, fifteen or even ten years ago and being a knew mother I can imagine that I might have fought against cancer like Sarah Thomas Monopoli did.
    Now being older and having experienced the limitations of medicine by seeing family members passing away, my attitude changed. I absolutely agree with Roach as she writes that “arriving at an acceptance of one’s mortality and a clear understanding of the limits and the possibilities of medicine is a process” (150). I know for myself that I would not want any unnecessary treatment facing a terminal illness. I rather would wanted to have the opportunity to talk with a professional in order to figure out how to spent my last days as comfortable as possible.
    Although my husband and I had already those conversations, I am really thinking about to write them down on paper, so my close family members really know and can make conscious decisions. Faced with pain we all to often project our own emotions on somebody else.
    I really believe that we should honor a person;s decisions about death, each on of us should have this right. I am not as familiar with the U.S. law. In my home country, Germany, patients can only be taken of life support or feeding tube when they have explicitly stated that such treatment should be terminated. In my eyes this is important, thinking that family members might be in such emotional state of mine not be able to make conscious decisions. All too often do we as human being project our own emotions onto somebody else.

  14. Facing Death has been a hard thing. Death is so final. But I believe that as christens that death is not final but the begin of a new life. I go into this story expecting what I don’t know. It was shocking to hear that she had a babe it was interesting and sad to expect her to die just after having a new baby. It was hopeful the hear that there a chemo therapy for them and I began to have hope. I was sad to hear that nothing still worked after trying a bunch of different things.
    The real question that I head in this is that what people should do if they have an incurable dieses. I think that the market needs to be more for experiment friendly. I have heard that there are alternate ways to treat the sickness. Pharmacia company and people who sue I feel are driving up the cost of the medical field. If people where less able to sue and the drugs to treat these sickness where cheaper then I find that it would be more cost effective.
    I think the people who are sick if of sound mind should decide when they should die. They often have different reasons why they want to go at their time of choosing and I have found that they often are more ready to go when they choose. There is nothing in this chapter that has changed my mind. I still see death as not a final chapter but the begin of the next and even better book.

  15. This week’s reading touched my heart. I think that all too many individuals can relate to this particular situation. The innovations in medicine have given our society incredibly high expectations for treatment courses. So when things aren’t going as planned, we keep searching for alternatives. This can be very dangerous for the patient’s well-being and the family’s emotional stability. It is hard to give up on a loved one, but, in my opinion, even harder to watch them suffer.

    I recently had a similar experience within my own family. My dog, Brody, was diagnosed with diabetes in February. In dogs, this disease is very difficult to treat and often times leads to a compromised quality of life. It was apparent to us that his condition was only getting worse even after changing treatments several times. Our priority was to ensure that he was not suffering through this process so, we had to put him down.

    I understand that our relationships with dogs and humans are quite different but, I think that the situations are comparable. It was important to us that Brody’s life ended with dignity. If we had let the disease continue its course, it would have been for selfish reasons. I think it is important to realize that in many cases we are prolonging the lives of our suffering loved ones for our own personal benefit. Although having them gone is painful, we must put their comfort and quality of life before our own emotions.

    • I agree, medicine nowadays has become so advance but also so invasive that, it may in the best interest of the patient to let them be. I know, myself through personal experience that watching a loved one suffer was worse than letting them be and let nature take it’s course. I can also relate to losing a loyal friend, my boyfriends dog was 19 years old, I don’t know what that is in dog years but he was great. I knew him for four years, and a year before he died he was diagnosed with a incredibly large tumor in one of his hind legs, ultimately we had to put him down too because it started to compromise with his quality of life. So, I feel your pain in losing a loved one or two.

  16. Death is inevitable, I’ve learned this throughout my life. We all live, and we will all die. There are some that wish to extend life to the very most edge, whether that being chemo treatment or just keeping someone comfortable until they’re time comes. I can think of a personal experience when my Aunt was diagnosed with stage III metastatic breast cancer, and I can feel Rich’s pain in the article when he states “We’re going to work through this. It’s going to be hard, yes. But we’ll figure it out. We can find the right treatment.” I regret it now, today, my whole family and I asked my Aunt to fight and fight hard when she was diagnosed. Given the fact that I was only twelve at the time, I still asked her to live for us. She did, she tried chemo, radiation, etc. She became very skinny and fragile. I wasn’t able to recognize her anymore she was so small. All in all, she did fight and she lost the battle to breast cancer. At the very least I can say that she left peacefully, when we all accepted the fact that we can no longer control the path of life and how it goes on.

    Cancer is not prejudice, cancer does not care if you are Native American, Occasion, African-American, European, etc. Cancer comes to those that we would least expect. Along with life and death. People that we would never guess to have become pregnant and bear children, have kids. People that often taken from us too us, death has become them. They are nothing left but a memory, locked in our hearts and memories. My own father was taken from me too soon, he used to say that “We are all in a line, we don’t know when our time is up but when it is, that’s it. There’s no going, there’s no more. Live your life and make it something you’re proud of, and always be kind.” I think death will always be a mystery to some of us, and I also think that those who leave us, I think they somehow know that they’re time is coming and they prepare themselves, so to speak. It’s a touchy subject to talk about.

  17. Reading this piece was incredibly hard. My grandfather struggled with heart disease and kidney failure and had to go to dialysis regularly until he decided he no longer wanted to go which resulted in his death. My mother has Crohn’s disease, rheumatoid arthritis, and endometriosis and undergoes remicade treatments every six weeks while taking up to 12 pills for pain and other symptoms three times a day. She constantly has her medications switched up and she often has to go to Seattle to seek better care. She often wants go give up and let nature run its course but she’s only 38 years old and she isn’t ready to give up. Reading this article shed a different light on my idea of care and options provided by doctors and hospitals and hospices as well. The article talks about how important it is to discuss what the patient really wants and what is most important to them in their limited time. It’s dangerous for doctors to beat around the bush with diagnosis and treatment for the patients because it could give them false hope. And all though it is important to try to remain positive I think remaining realistic is most important. Death is a scary thing to face and it can be horrifying to know the end is near for you but I think if I had a terminal illness, I would go to a hospice rather than undergo surgery or constant treatment that will cause unbearable side affects. I think the wishes of the patients should always be honored.

    • I am sorry for your loss. Reading your response has reminded me that no one knows what it’s like to be in situations such as yours until they have actually experienced it themselves. I think that it’s great that your mom has decided that she is not ready to give up and is continuing to fight. I agree with you that it is very dangerous for doctors to be beat around the bush with their patients, remaining realistic is definitely most important.

  18. The “Let It Go” article was interesting and easy to read. So many of us live without ever stopping to think that life could come to an end sooner than planned. We tend not to like thinking about death and what we would do in life or death situations. There are so many different scenarios that really no one could prepare you for. Do you accept treatment that could buy you a couple more months, or do you just enjoy the time you have left and deny treatments? Should you take your mother or father off of life support or keep them on life support? Decisions such as these are some of the hardest choices someone will probably ever make. While we may like to think other wise, everyone will have to face death at some point. Weather it be with a family member, a friend, or even ones own life.

    There have been many debates on terminal illness and if people should be given supplements to speed up the process of what could be a long and painful death. In states such as organ, it has been legalized to allow people with terminal illnesses to consume a liquid form that will end their life with in a matter of hours. The right to assisted suicide allows for people with illnesses to not only say goodbye to loved ones, but it also allows them to go in peace. While some do not agree with this, I believe that everyone should be able to make that choice for themselves. People with illness that will only result in a slow and painful death should be able to make such a call for themselves. I know if I were in pain everyday I would reach a point of no longer wanting to suffer.

    On the other hand I also personally believe that people should educate themselves on terminal illness. While yes, you can’t always prevent such illnesses from happening, you can live a healthy life style that will lower your chances of such illnesses. New discoveries and ideas on how to prevent cancers and other illnesses should be taken seriously.

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