Letting Go

I must admit, I was surprised and pleased at the attention given to my recent blog post, The High Price of Dying. It was - by far - my most viewed and popular entry to date. It made me realize that the topic of accepting death and letting go of those we love is on the minds of many of my friends, colleagues and readers.

It also got me to thinking, “why can’t we let go” or “why can’t we let go more easily?”  This question led me back to my office bookshelf, and to the pages of Atul Gawande’s Being Mortal: Medicine and What Matters in the End.

In what I found to be an incredibly insightful book, Gawande examines the ways in which the medical establishment in the United States, when caring for the elderly and terminally patients, expends the greatest amount of energy trying to keep patients alive and “safe.” He posits how the focus can begin to shift to make the time left as meaningful and fulfilling as possible.

This book really resonated with me and I agree with Gawande. We tend, both as humans and as medical professionals, to disassociate thinking of those last weeks, days and months as part of the patient’s entire life. We focus on simply getting through those moments instead of honoring the spirit and ways in which they have lived their life up until that point. We need to recalibrate our professional and personal lens in order to provide the most meaningful assistance possible in the final days of life.

As Gawande explains, “A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”

But what does this mean, practically? Not only do patients need to have their legal and medical ducks in a row, but patients, physician and families need to have hard end-of-life conversations before it is too late. I have even heard of some doctors making this conversation a component of a patient’s annual exam. In addition, we need to reexamine not only what end-of-life care looks like but how and the environment in which it is provided.

I have reflected lately about the totality of my own father’s life and how the choice we made for him in those last days served to honor the way he lived. I think every patient deserves that.