“Being Mortal: Medicine and What Matters in the End” – Atul Gawande
“Well, you’ve got your health.” My dad would say this to me often when I was young and tearfully making some problem bigger than it needed to be. Having undergone two open-heart surgeries, he understood how much of a gift good health is, and how precarious it can be.
Atul Gawande, a surgeon, and a writer for the New Yorker, a professor at Harvard Medical School and the Harvard School of Public Health, writes clearly and compassionately about the realities of aging and dealing with terminal issues.
We live in a culture that glorifies youth and supports the fantasy of agelessness. When we’re young and healthy, the realities of old age seem almost unfathomable. With every advance in medicine, we expect the benefits to make our lives easier, with the expectation that we will live longer. We expect to go to the hospital when something is wrong and to be cured.
This book explores what happens when a cure isn’t possible. It’s a riveting examination of how our society approaches the inevitability of aging. Through many case studies, Gawande writes about patients he’s treated and his early failures in communicating openly with them. He says too often doctors get into the “information” mode, where they talk of all the things they can try while losing sight of whether any of those options are what the patient might be willing to endure.
In fact, most doctors are probably more comfortable offering yet another treatment option, no matter how much of a long shot it might be. The goals of many doctors and the medical profession, in general, seem to always be looking for a way to “fix things”. It’s what they’ve been trained to do, solve a problem, attack the illness with every weapon in their arsenal. The trouble is, this sometimes creates unnecessary suffering for the patient and their families. When should we try to fix and when should we not?
The important questions become: “If time becomes short, what is most important to you? What is your understanding of the situation and its potential outcomes? What are your worries? What trade-offs are you willing to make, and not willing to make?”
With the average lifespan often climbing into the 80’s, many of the natural frailties of life are ever more present, which is a situation that the medical community has been unprepared to deal with.
A thought-provoking statistic: Today, we have as many 50-year-olds as 5-year-olds. In thirty years, there will be as many people over eighty as there are under five.” Seems like it’s beyond time to address the needs of this aging population (and I’m one of them.)
Yet, 97% of medical students take no courses in geriatrics. The lure of high-paying specialties draws much more students into practice than the care of elderly patients. However, it’s been proven that geriatric nurses and doctors who can tend to the needs of the aged can make a big difference in how well the patient feels cared for.
“People with serious illnesses have priorities besides simply prolonging their lives. Surveys
find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete.”
Atul Gawande raises the question of how we can make sure our life comes to a good end with the wishes of the person respected.
“We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons wishes to be alive”
Gawande notes that understanding the “finitude of one’s time can be a gift.” Having seen close relatives deal with terminal illness, I fully embrace that perspective.
And this: “Death, of course, is not a failure. Death is normal.” And we want to end life on our own terms. This book helps us look at how we can accomplish that.