The article I am reading is Letting Go by Atul Gawande. In the article he talks about a big issue in healthcare, which is how modern medicine is good at staving off death with our advanced interventions, but sometimes they are to good at staving it off because in many cases doctors dont know how to focus instead on improving the days these terminal patients have left. And even in some cases the doctor will know that he or she should focus on improving their last days but they still wont because most the time they want to try and get as much money as possible from an insurance company, or they also may have new drugs that are in trial stages still and they will bring up that drug to the patient in order to get them to try it so the doctor can see how well it works. Even if the doctor knows it wont help the patient, which can give the patient and their family false hope or even make the patients condition worse than it was.

Atul Gawande starts the article by talking about a patient named Sara Monopoli and her familys struggle to overcome her unexpected lung cancer. When Sara learned of her terminal condition she was nine months and 3 weeks along with her first pregnancy. Her condition started off with nothing more than a cough and some back pain, but then an x-ray revealed that her left lung had collapsed and her chest was filling with fluid. After the x-ray an oncologist sat down with her and her family and broke the news, the doctors wanted to start her on treatment but first they had to induce her into labor, some time after her daughter Vivian Monopoli, seven pounds nine ounces was born perfectly healthy. Sara was only thirty-four, she had never smoked or lived with someone who had, and she excercized and ate properly, which goes to show poeple that something life threatening can happen at any moment and usually when we least expect it. Once her child was born they started looking at treatments, the first being a new drug at the time called Tarceva which targets a gene mutation commonly found in lung cancers of non-smoking women, her doctor told her that eighty-five percent of patients respond to the drug some of them long term. The Tarceva caused Sara to get an itchy acne like facial rash and numbing, while she also had to have a small permanent tube surgically placed in her chest to be able to drain the fluid in her lungs. After then also having a pulmonary embolism, test showed the Tarceva wasnt working, and the doctor then recommends two more drugs called Carboplatin and Paclitaxel, The Paclitaxel caused an extreme allergic reaction so she was switched to Carboplatin plus Gemcitabine. Even after none of these treatments show improvement she is again switched to another drug Pemetrexed, which studies showed it could produce much longer survival time in some patients, in reality however only a small percentageof people gained very much, and that was in patients who unlike Sara had responded to the first line chemotherapy. And even though Sara wants to pursue treatment its easy to see how her doctor is somewhat making her worse, he keeps giving her new drug regiments even though the doctor should know some of them wont work. She then had a CT scan which not surprisingly showed the drug once again wasnt working. Atul Gawande then starts talking about her going on rounds with a nurse named Sarah Creed who works with the hospice service. The first patient they see is a seventy-two year old woman named Lee Cox who has pulmonary fibrosis, a progressive and uncureable lung disease. She had chosen hospice and moved in with her neice because her disease left her unable to do most task and she needed a constant oxygen mask to breath. They then meet with Dave Galloway and his wife Sharon who are Boston firefighters who have a three year old daughter. Dave has pancreatic cancer which caused him unbearable pain and had caused tumors to form in his abdomen and his intestines which doesnt even have a temporary fix, so the medical team gave him the choice of intensive care or hospice, and he choose hospice. At first Dave seemed to have only days left, but his nurses and family got to work making him as comfortable as possible and they taught Sharon how to keep him clean, and she seemed most capable. Perhaps because she was a firefighter, she was determined to take care of Dave to the end, and had the resiliance to do so. Dave Galloway eventually died at home, and at peace surrounded by family and friends, a week after Lee Cox died as well. Gawande then goes back to Sara Monopoli who had met with her doctor to go over her options. Sara knew her condition was incureable, she had given her wishes for her daughter Vivian the week she was born, Sara wnated to keep going to the next treatment but it seemed they were out of choices and Sara did not want to die in a hospital bed. Unfortunetly Sara’s fate would not be similar to the others. Her condition only kept getting worse as she had gotten a second diagnosis of cancer in her thyroid which spread threw her glans. She was also diagnosed with pneumonia which in a way reassured her family but in fact made her breathing much worse and the next morning was put on a ventilator in the intensive care unit, her wish of passing peacefully at home might not come true.