6 •Letting Go

BeforeI beganto thinkabout what awaits my older

patients—people very much like Lou Sanders and the
others—I’dneverventuredbeyondmysurgicalofficeto
follow them into their lives. But once I’d seen the
transformationofeldercareunderway,Iwasstruckby
thesimpleinsightonwhichitrested,andbyitsprofound
implicationsformedicine,includingwhathappensinmy
own office. And the insight was that as people’s
capacities wane, whether through age or ill health,
makingtheirlivesbetteroftenrequirescurbingourpurely
medicalimperatives—resistingtheurgetofiddleandfix
and control.Itwasnot hard tosee howimportantthis
ideacouldbeforthepatientsIencounteredinmydaily
practice—people facing mortal circumstances at every
phase of life. But itposed a difficultquestion: When
should we try to fix and when should we not?

SaraThomasMonopoliwasjustthirty-fourandpregnant
with her first child when the doctors at my hospital
learnedthatshewasgoingtodie.Itstartedwithacough
andapaininherback.ThenachestX-rayshowedthat
herleftlunghadcollapsedandherchestwasfilledwith
fluid.Asampleofthefluidwasdrawnoffwithalong
needle and sent fortesting. Insteadof an infection,as
everyone hadexpected, itwaslung cancer, and ithad
alreadyspreadtotheliningofherchest.Herpregnancy
wasthirty-nineweeksalong,andtheobstetricianwhohad
orderedthetestbrokethenewstoherasshesatwithher
husbandandherparents.Theobstetriciandidn’tgetinto
the prognosis—she would bring in an oncologist for