Monday, April 27, 2015

Being Mortal by Atul Dawande

Being Mortal
by Atul Gawande
2014
*****
5 stars - well written and informative


Everybody dies. Everybody. It's the only certainty of the human condition. And yet, it is the very aspect of our existence that is talked about the least. No more so than amongst family members and the medical community. 

So let's talk about it.

Dr. Gawande is a surgeon at Boston's Brigham and Women's Hospital and the author of several previous books focused on how to improve the care given by medical professionals. In this book he tackles the end of life. Whether it comes gradually due to the wearing out of age or unexpectedly due to disease. In either case, talking about what can and cannot be done, what should and should not be done is critical.

The first part of the book discusses options for senior citizens, some good, some bad. Nursing homes, assisted living, in-home care. The second half focuses on terminal illness in people of all ages.

Throughout the book, Dr. Gawande gives specific examples of how to have important conversations. He discusses finding a way to allow people to continue to be the "authors of their lives" regardless of circumstances. By that he doesn't mean total freedom, but rather to identify the specific aspects of a person's life that has value to them. It even means freedom that might include risk of injury, but that also provides a quality of life, as opposed to just existing. 

Three questions that he asks patients repeatedly;
  1. What are your biggest fears and concerns?
  2. What goals are most important to you?
  3. What trade-offs are you willing to make and what ones are you not?
The medical community is woefully unprepared to handle an aging population or to assist end of life decisions. Medical programs offer, at most, one class on geriatrics and possibly a lecture on end of life. Dr. Gawande is an advocate of making end of life education a more prominent part of every doctor's training.

My 84 year old mother gave me this book. She told me to read it and then we would talk. It made me realize how little I understood about her wishes at this point in her life. That, despite the fact that I am her medical proxy. I will have that conversation, and soon. Does it make me sad? Yes. Do I want to talk about it with her? Nope. But if I do, if we are clear with each other, then no matter what the future holds, I can be confident that I am helping her have the life that she wants for as long as she can and that's a good thing. That's a gift we all need.

2 comments:

  1. Even when my father was dying, he and my mother couldn't face it, other than the "Oh, we have a living will" type of statements. I had to fly to Florida in the middle of a complex commercial real estate transaction and deal with the nursing home, to get him moved to Hospice. And the Hospice rules are insanely complex, too. You should have seen the look on the doctor's face when I told him that he was simply trying to tell me to keep my father alive because they need live bodies to create billings and money. And everyone involved was stunned when I got him moved from long term care to hospice in 36 hours, including all of the medical evaluations and so forth; it was never done in that time before, or so I was told.

    2 years before my mother died, I had to go to Florida and get all of my mother's doctors on her page: she was not going to survive this cancer, and wanted no more chemo treatments. Again, many doctor visits, many unpleasant conversations with the health care professionals, and again I told them that my mother wasn't going to just be their "live body" to enhance the income of all of these establishments and still suffer. That was the real thing, to her: not to suffer. But medical professionals just want to prescribe treatments, suffering be damned. Watch that with your mother, because it's really hard to stop that rock once they set it rolling. It's a good thing that someone actually wrote this book.

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  2. hello mango momma its dennis the vizsla dog hay this sownds like an importent buk!!! dr gawande offen rites for the noo yorker and dada sez his artikuls ar always intresting eeven wen they ar sumwot somber!!! ok bye

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