I had the pleasure of reading Atul Gawande's latest essay on National Day. Written in his typical eloquent style, "Letting Go" tackles the issue of dying and how modern medical care is ill equipped to deal with it. Much of the writing revolves around patients with terminal cancer, a particularly difficult subpopulation in the sense that there are so many new therapeutic agents now available (with far more to appear over the horizon), yet these patients remain in a situation where death seems "more inevitable" compared to patients with end-stage heart failure or obstructive lung disease.
Most of the new (and old) therapeutic agents for metastatic cancer offer more hype than hope, and the symptoms they ameliorate at remarkable financial costs (in Singapore, few chemotherapy drugs are subsidized in the public sector) are sometimes replaced by the toxicities of the drugs. I am sure virtually all oncologists understand that with most chemotherapy, they are providing symptomatic relief and prolonging life by several months on average, but the patients and their families generally do not truly understand this at the start, wishing against hope for a miracle that almost never appears. And in some patients, this hope can go too far when they search desperately for ever more experimental drugs and miracle cures on the internet that less scrupulous practitioners may be willing to provide.
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