Fat Books & Thin Women

#Longreads: Atul Gawande’s “Letting Go”

Occasional posts highlighting some of the best longreads on the web. Trying something new this week, and posting on Friday. Your thoughts on this week’s read, and suggestions for future articles and essays, are always welcome!

Atul Gawande’s “Letting Go” comes at the issue of dying from a few directions: the story of a new mother and woman with incurable cancer, Sara Thomas Monopoli; home visits with a hospice nurse; a look at the changes medical innovation and the intracies of health insurance have wrought on death in America; and Gawande’s own attempts to discuss the end of life with his patients.

Gawande’s essay succeeds because he never hesitates to ask questions that can’t be answered, or to condemn even himself for the way he discusses (or doesn’t discuss) death with his patients. Gawande illuminates a part of life that few of us want to think about until it’s inevitable. As he points out here, that reluctance to discuss the end of life may well be making the ends of our lives, in America, more miserable, fraught with false hope and painful treatments, than they should be. This hasn’t always been a problem; until relatively recently, Gawande notes, people took it as a fact of life that some people would be suddenly stricken by illness and, as soon as a few days later, leave this mortal coil. But now, in part because of the seeming conflict between the doctor’s job of curing patients (even from the incurable) and helping patients to die, we are lost.

I wasn’t even sure what the word “dying” meant anymore. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.

This is fascinating and gorgeous writing about a topic too many of us don’t want to touch. Gawande elegantly shifts between Sara Monopoli’s story (which by end will have you wanting to scream, to tell her family how to treat – or not treat – her incurable and spreading cancers, even as you know that were she your own relative you would be desperately googling for the miracle cure) and ideas for how we might find our way back to knowing how to die. What Gawande suggests, that little more than discussion may be the key to reducing needless treatments at the end of life, is simple and revelatory at the same time, as is his consideration of a few cases in which insurance companies and health systems have reduced end-of-life costs while increasing the satisfaction of patients and their families. Attempting to bring these questions into the open, and making them a standard part of end-of-life care, has got to be better than our current system, of which Gawande writes:

We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets – and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan.

Read Atul Gawande’s “Letting Go”


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