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Reduce medication errors with manufacturer-enabled RFID. CrossFit to launch 'fully digital' primary care service. How analytics can help providers capture money they're leaving on the table. How interoperability is affecting health outcomes. She decided to take a vacation with her family, and when she returned, she took a break from chemotherapy, refusing to be weighed down by the side effects. This enables Douglass to weigh her priorities.
Instead of chemotherapy, she goes on vacation to spend time with her family. She prioritizes her well-being over living longer, and Gawande helps her achieve this goal. But he visits his grandchildren more often and puts in an extra trip to family in India.
As time goes on without his symptoms worsening, his ambitions return once again—he runs for district governor of Rotary for southern Ohio and wins. Then, two and a half years after his diagnosis, his symptoms change—he develops more numbness in his right hand. He retires, but still waits to get the surgery.
He throws himself into his work as Rotary district governor, determined to control his life and adapt after losing his work, something that mattered so much to him. This means both having meaningful personal experiences, like time with family, and the ability to achieve professional accomplishments. Even though he has to give up his surgery practice, he still feels that he has more he wants to do before resigning his life to the various medical treatments he knows he will likely have to undergo, or the debilitating side effects that might result.
He and Gawande then have a difficult conversation. In turn, Gawande asks what his father wants out of the end of his life. Afterward, they are both relieved to have had the conversation. Only by understanding those priorities can Gawande help his father achieve them, and even though it is a difficult conversation, he shows how relieving it is for both of them to have the discussion.
Two hours into the surgery, his father goes into an abnormal cardiac rhythm and his blood pressure drops. The doctors stabilize him, but there is uncertainty about proceeding, and Benzel comes out to consult Gawande and his mother about what to do. Gawande knows from their conversation that his father is more concerned about becoming quadriplegic than dying, and so he asks which carries the greater risk: stopping or proceeding.
Benzel says stopping, and so they ask him to continue the operation. This is why the conversation between Gawande and his father proves so critical. Knowing that his father is more concerned about becoming paralyzed than anything else, Gawande is then able to make an informed decision about how Benzel should proceed with the surgery.
If they had not had the conversation, Gawande might not have made the right choice for his father. He returns home feeling stronger than ever, walking and experiencing little neck pain. He made the choices that mattered to him.
Not only is Gawande relieved to have had the conversation, but the outcome of the surgery shows how important it was for his father. And in the end, nothing improved. He lost weight because he had no desire to eat. The numbness in his left hand spread, and he also gained numbness in his lower extremities. He gets vertigo and his neck and back spasms persist. After a six-month MRI, the tumor has expanded. Gawande and his father and mother see a different oncologist, but she, too, proceeds in information mode, laying out eight or nine chemotherapy options.
She says that the likelihood of tumor response is 30 percent. He asks if the drugs will make his side effects worse, and she allows that they might. She takes them through each of the drugs, but the conversation becomes confusing and data-driven.
The oncologist explains his upper and lower extremity weakness would increase, and difficulty getting oxygen would become the biggest problem. The first is pain. Dying patients are fearful of pain and must be helped with their pain. The second one — which was a shocker to me — is abandonment. That word hit me hard.
When I returned from the meeting, every night I made it a point to visit that young patient, sit on her bed and talk to her. I think I made a difference to her, and it made a huge difference to me, cementing in my brain the importance of communication and the concept of abandonment and how to dialogue with dying patients.
Perez Protto: So dialogue is invaluable, but is there ever an appropriate time to be paternalistic? Perez Protto: How do you balance hope and realism when counseling a patient with a terminal disease? Such conversations make them uncomfortable. Perez Protto: No one is comfortable talking about death. How do you talk about possible complications, including death, during your consent process for surgery?
Benzel: I have a checklist that I pull up on the computer. I go over all the points, with the patient looking at the list with me. After we talk about the potential negative consequences of surgery, the last thing on the list is death.
He also speaks on how to improve care and lower costs. Atul Gawande is the author of three brilliant bestselling books on medicine, culture and human experience. His first book, Complications , was a finalist for the National Book Award in and is published in more than a hundred countries. In this book, Dr. Atul Gawande explores the importance of using the lowly checklist and how it has revolutionized medical practice and saved lives.
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