Question

“The Best Possible Day” by Dr. Atul Gawande, how do you believe Peg Bachelder resolves Erikson’s final psychosocial stage? Please give at least 3 specific examples to justify your answer.

Answer 1

Dr Atul Gawande is another author who writes on his personal experiences with end of life care and who stresses the importance of planning ahead and having a critical end of life discussions with patients in order to fulfil their final wishes and provide the best possible care.  Gawande focuses more on the difficulty that the patient, physician, and family have when deciding when to “let go” and how ignorance of modern medicine’s limits can lead to frustration and misunderstanding when faced with such a decision. The term “letting go” that Dr Gawande is referring to does not mean simply giving up on the patient, nor does it mean the patient is finished enjoying life, nor does it mean the family members have stopped caring for their loved one. The term letting go refers to the point at which the patient, physician, and family have discussed the terminal condition of the patient and have all accepted the fact that modern medicine will never completely cure the patient. It is at this point that all involved in the process decide to follow through with the patient’s final wishes in order to provide the highest level of care. Gawande also stated that he personally found it easier to discuss further experimental treatments with his patients than it was to discuss their end of life wishes when they are particularly optimistic. This only adds further complexity to the primary issue here and increases the difficulty of having an end of life discussions between patients and their doctors.

Dr. Gawande’s article entitled The Best Possible Day illustrates his personal attempts at solving this end of life care problem with several different methods. The article begins with him receiving a call from the husband of Peg Bachelder, his daughter Hunter’s piano teacher. Peg’s husband informs him that Peg is in the hospital. She had been treated with chemotherapy, radiation, and radical surgery when she was diagnosed with a rare pelvic cancer in 2010. Peg was now suffering from a leukaemia-like malignancy caused by her treatment. She was sick with fevers and an infection which imaging showed to be caused by a relapse of her original cancer in her hip and liver. Doctors gave her blood transfusions, pain medication, and steroids for her fevers.
Being consulted as a family friend, Dr Gawande now asks himself what the correct route to take from this critical point in time is, much like Sara’s doctors had done in Letting Go. Should Peg continue treatment or “give up”? He goes on to talk about how he felt ill-equipped to handle these sorts of situations for the previous decade. He often felt unable to help some of his patients facing these tough decisions or his father who was then in his 70’s. To combat this, he had researched managing mortality and how society could improve upon doing so. For three years Dr Gawande spoke with over 200 people about their experiences with ageing, serious illness, and family members. He interviewed and shadowed staff at retirement homes, palliative care specialities, hospice workers, geriatrics, nursing home reformers, pioneers, and contraries. During his years of research, he made two fundamental discoveries: people have priorities other than living longer and the best way to learn these priorities is to ask them.
In addition to these two fundamental discoveries, Dr Gawande found that the most successful physicians were those who asked four important questions: What is your understanding of your health or condition? What are your goals if your health worsens? What are your fears? What trade-offs are you willing to make or not make? (Gawande, “The Best Possible Day”). The answers that patients give to these questions inevitably change over time and should, therefore, be asked continuously. They are the questions that Dr Gawande decided to ask Peg in order to determine what he would advise her to do next. She answered the first by saying there was nothing the doctors could do to save her life and that she was going to die. She answered the second by saying that she had no goals that she could fulfil in the amount of time she had left. She answered the third by saying that she was afraid of experiencing more pain, suffering and humiliation from losing more body control and being unable to leave the hospital. Because of Peg’s answers thus far, Dr Gawande decided to suggest that she try going on hospice in an attempt to achieve one good day that she had not experienced in quite some time. As Dr Gawande spoke to his Peg, he attempted to express that, “Hospice’s aim, at least in theory… is to give people their best possible day, however, they might define it under the circumstances” (Gawande, “The Best Possible Day”).

Peg chose to take Dr Gawande's recommendation and attempt hospice trying to keep educating as long as she could. The hospice mind pros initially worked with her to set littler objectives, for example, overseeing day by day troubles to give her control over her difficulties. They did this by moving her bed to the primary floor, arranging out washing and dressing, and changing her solutions to fit her level of the coveted solace. Her tensions diminished drastically as her sights raised on instructing indeed. It was critical to her to have the capacity to state farewell to her companions and to give separating counsel to her understudies.
Peg lived for six weeks after going on hospice, four of which were spent teaching and two final concerts were played. A week after the last concert she fell into a delirium and died peacefully in her bed. The last memory Dr Gawande has of Peg is when she gave his daughter a music book and put her arm around her to tell her that she was special. This was something she never wanted her students to forget.
After Dr Gawande had recognized the core issue of patients not having these critical discussions about end of life care with their doctors and nurses, he implemented his own form of a solution. Once he discovered that people have priorities other than simply living longer and that the best way to find out what these priorities are is to ask them, he initiated a discussion with his friend that included asking a specific set of questions that would help guide him in his attempt at suggesting the best possible route of care.

The gist of the article shows that Peg wanted to fulfil her last desires of teaching before she died. This is similar to Erikson's final stage of ego integrity vs despair.

At the last stage of the Erikson stages, individuals are in their 60s or older who are normally retirees. It is critical for them to feel a feeling of satisfaction realizing that they have accomplished something huge amid their more youthful years. When they think back in their life, they feel content, as they trust that they have carried on with their life minus all potential limitations. On the off chance that they feel that they haven't done much amid their life, it's possible that they will encounter a feeling of despair.

The greater part of the general population's lives are spent getting ready for the center adulthood stage. Then again, old-aged grown-ups in this stage manage thinking about back their lives. As they think back, some vibe content and satisfied for they trust that they have had a huge existence and contributed generously to their condition. In any case, some vibe a feeling of despair for they see a greater amount of their disappointments and in that capacity, these individuals may encounter dread of death as they are as yet not finished with hunting down their life's importance. This is the stage when people would solicit, "What was the point from life?"

Amid this period, the individual encounters a feeling of integrity when he feels pleased with his accomplishments and is happy with the hand that he was managed. With the experience of integrity, the individual has few second thoughts or recriminations. This, notwithstanding, is genuinely conceivable just if the individual has effectively settled the other seven psychosocial emergencies. With fruitful determination of prior emergencies, old-aged individuals are probably going to think about their lives decidedly and accomplish insight even despite impending demise. Changes between past stages of Erikson's hypothesis progressed toward becoming clearer and feeling content with the world and the self-turns out to be more obvious.

Then again, individuals who are unsuccessful in this stage encounter despair or appall. Old-aged people feel that they have squandered their lives and experience many second thoughts. They feel severity towards what they were not ready to do in their lives and impractically trust that they would have the capacity to turn back the hands of time for renewed opportunities.Virtues of "wisdom" and "renunciation" create when the individual has accomplished solid resolutions to the emergencies he has encountered. These ideals are described by self-restraint, broadmindedness, fitting enthusiastic abstinence – non-projection, appreciating genuine feelings of serenity and otherworldly compromise, and having no second thoughts. On the other hand, a malignancy of "despise" is experienced and maladaptation of "assumption" happens when the individual has neglected to determine the difficulties he looked amid the present or even the past stages. The individual shows "hate" by feeling hopeless and unfulfilled and resorts to visit faulting. "Assumption," then again, is displayed by getting to be plainly vain, vainglorious, and pompous.

This way Peg resolves Erikson's final psychosocial stage. The need of fulfilment is shown by the need to teach again, make her students perform which gives her an instant gratification that she did something fruitful in life and by not blaming anyone for her misery.