Morgan Feshler
SOAPSTone
September 9, 2010
AP Lang and Comp
“Letting Go” by Atul Gawande
1. S – Speaker: The writer proves his credibility and authority in a variety of ways. The most
evident and perhaps most important way is his use of multiple examples of different people’s
stories. He tells the story of a young mother, Sara Monopoli, with terminal lung cancer, an
elderly woman named Lee Cox who was in consistent overall health failure, Dave Galloway, a
middle aged man with pancreatic cancer, and a few other people whom of which he describes the
story of their illness and its effect on their lives. Gawande not only provides to the reader these
patients’ personal insight into their situations, as well as his own personal insight and opinion,
but he also provides relevant factual evidence and statistics to support the point he is trying to
make, which has a definite impact on his credibility as a writer.
2. O – Occasion: Currently, America is facing some difficult challenges involving paying for
medical insurance, among other things, and perhaps it was things like this that prompted
Gawande to write this article. One major focus of this article is the question of whether or not
these trillions and trillions are dollars spent on medicine are being put to “good” and practical
use, and this question is directly connected to America’s current medical finance issues.
Looking beyond how scientific and financial questions were involved in the creation of this
piece, it is evident that Gawande wrote this article after years of simply observing the different
behaviors and medical decisions of patients. In the article, he constantly brings up patients of his
as well as those of other doctors, and he describes the stories of their battle and certain decisions
they make and observations he has made, and ultimately conclusions he has drawn. His very
intense observations posed many questions as to why certain things happen; why did this patient
finally decide to turn to hospice care? Why are we spending millions of dollars of methods in
attempt to save terminally ill patients whom we know have no chance of survival? Is open
discussion about one’s disease really that important, important enough to perhaps make one’s
death more peaceful for both themselves and their loved ones? It was questions like these that
Gawande had cumulatively formed over his years as doctor and surgeon that prompted him to
research and write this article.
3. A – Audience: This piece is directed to seemingly anyone, although there are several
occasions in which the author writes of things that many readers can connect to. Most people
have dealt with the loss or sickness of a loved one, and thus dealt with the many decision that
come with this, and of all the examples Gawande provides in his article, the audience will be
able to relate to some story in some way, so it is perhaps these people whom of which can
connect and relate that Gawande is reaching out to. The author could also potentially have had
other doctors in mind as he was writing this piece. He references different approaches doctors
have made when both treating and talking to their patients, like their particular use of words
when discussing a patient’s prognosis or treatment options, and he describes both the benefits
and disadvantages of certain methods, perhaps intending to cause these doctors to analyze their
work and their particular approach, both medical and emotional, and to maybe even change their
future courses of action.
4. P – Purpose: Gawande’s claim and argument is that too much money is put into trying to
save terminally ill patients’ lives by intensifying chemotherapy or performing major surgery that
will have little to no effect on their lifespan, simply because the doctor isn’t willing to flat out
give the patient and family the option of giving up, and because the patient isn’t willing to let go.
Gawande explains that by undergoing all of this intense and debilitating treatment at the end of
their lives, patients dramatically reduce the quality of those last few days they have, because
they’re hooked up to a machine or suffering from some of the drugs’ harshest side effects,
leaving them unable to live those last few days and die peacefully. He also talks about how
important honesty between doctor and patient is, and not only this, but how important the
doctor’s particular choice of words can be and how much of a difference it makes when instead
of saying, “‘What do you want when you are dying?”’(13) you say, ‘“If time becomes short,
what is most important to you?”’(13). By explaining to the reader all these things, it gives them
much to think about, and perhaps Gawande wanted to have an influence on certain future
decisions of terminally ill patients and their families as far as treatment and care options when it
gets closer to the end. Gawande’s friend and hospice nurse Sarah Creed explains that, “In
ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence nowby performing surgery, providing chemotherapy, putting you in intensive care-for the chance of
gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a
fatal illness have the fullest possible lives right now. That means focusing on objectives like
freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or
getting out with family once in a while,”(5). All terminally ill patients have the option of this, or
to keep fighting and debilitate themselves in those last few moments of their life. Gawande
wants to express this to the readers, and hopefully have an influence on certain decisions they
make if ever faced with ones as such, perhaps encouraging them to focus on quality of life, rather
than the length.
5. S – Subject: The subject and main discussion of this article is the question of why so many
terminally ill patients opt to keep fighting despite all the odds against their survival, instead of
turning to hospice and focusing on improving the quality of their last days, and it also greatly
focuses on the positive effects of honest and open discussion between doctor and patient, family
and patient, etc., and how affective this is on when the patient dies and exactly how they leave
this world and their loved ones behind. The subject of this article is both explicitly stated and
indirectly implied. There is not one specific quote, necessarily, that definitively states the
subject, however, the multiple examples of particular patients’ story supports the claims of
importance of discussion, the choice of certain patients as to how to spend their last days, etc.
extremely well and directly.
6. Tone: There is definitely a tone of sincerity in the article. As he discusses the stories of the
patients, Gawande doesn’t just factually tell the story, but he tells it with sympathy, admiration,
and even fascination, which all seem to tie together and create this sincere piece. As he uses
harsh words seemingly too truthful, Gawande somehow is able to put sentences together in a way
that is not so harsh, but simply honest and sincere. For example, “…Sara ended up on a fourth
round of chemotherapy, one with a minuscule likelihood of altering the course of her disease and
a great likelihood of causing debilitating side effects. An opportunity to prepare for the
inevitable was forgone. And it all happened because of an assuredly normal circumstance: a
patient and a family unready to confront the reality of her disease,”(8). The words in these
sentences and the harsh reality they are describing are brutally honest, however, at the end of it,
the reader feels this sense of sympathy and sincerity from the author, who had stated that all of
what Sara was going through was incredibly useless and perhaps worse than the option of just
accepting the fact that she was dying, and do so peacefully, yet he did not necessarily disagree or
say she was wrong, for Gawande understands how hard it is to just give up and accept death.