by Atul Gawande
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;
- What are your biggest fears and concerns?
- What goals are most important to you?
- 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.