Dr. Atul Gawande’s Being
Mortal tackles many of the elder care issues my wife and I have been
dealing with for close to a decade. Each
of us has been the primary caretaker of our elderly parents (only our fathers
survive at this point) for that long now, and just when we think we have seen
it all, something new catches us by surprise.
I only wish that we had come across a book like Being Mortal ten years ago rather than having to learn the hard way
much of what the Gawande has to say in it about aging and death.
Life is all about the choices we make. And the choices we make as we approach the
end of our lives – or the choices we help loved ones make as they approach the
end of their lives – are every bit as
important as any we have ever made.
Faced with the choice between prolonging our lives for a few months at
the cost of losing the quality of our remaining time or living more comfortably
and autonomously for what time we otherwise have left, what do we do? The right choice is never as obvious as one
might hope it would be. Gawande suggests
that quality over a slightly extended length of time is the wiser choice,
difficult as that choice may be to make when the time comes.
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| Dr. Atul Gawande |
So why do we face such a dilemma in the first place? Gawande blames much of the problem on the
medical profession. Most doctors, he
says, are so reluctant ever to give up on a patient that, despite the
additional agony involved in further treatment, they will try one hopeless
procedure or drug after another until that patient finally dies. They effectively destroy the remaining lives
of their patients by failing to disclose the inevitable result to them: they
are going to die soon and it cannot be avoided.
Gawande argues that, rather than something for the doctor to decide,
this ultimate choice must be placed in the hands of the patient. Medical problems that cannot be fixed even at
great physical and mental cost to the patient must be managed rather than fixed.
And it is up to the doctor to recognize when that point has been reached
so that he can help his patient make the right choice.
My personal experience and observation, as verified by Dr.
Gawande in Being Mortal, tells me
that dying in the U.S. has become a big business. For the most part, our elderly no longer die
at home; they more often die in some hospital or nursing home with a nurse or
two around to record the event. It is
all very impersonal and routine these days.
But Gawande is not ready to give up on his profession. The growing trend toward the use of home
hospice services and the efforts of some medical schools to train their
students more fully gives him hope. His
greatest fear is that so few medical students are choosing to specialize in
geriatric medicine that the elderly will suffer unnecessarily for a long time
to come.
Being Mortal is an
excellent resource for anyone faced with life’s inevitable choices – the
hardest choices any of us are ever likely to have to make.
I've read something else positive about this book. I've already been through the situation of dealing with the end of life with my parents and was frequently so angry with both attitude and lack of choices.
ReplyDeleteJenclair, I wish we had found something like this ten years ago. The doctor has a way of putting the whole struggle into a context that makes perfect sense...even though he admits in the book that he and his father found it extremely difficult to make the right choices when their turn came to make those choices.
ReplyDeleteI think with any situation, it's our natural human desire to fix whatever we perceive as broken, or not working correctly anymore. If the possibility is there, we want to take it. So hard to accept that the inevitable might be so close already, it's not worth the suffering to make those attempts. I hope when the time comes for my parents (or myself, further down the road!) to go through those moments, we'll have an understanding doctor who can take us through the possible choices and their pros/cons respectfully.
ReplyDeleteHaving observed my father and in-laws go through the dying process, I've come to believe that a person somehow knows when the proper time to let go arrives. There seems to be a calming effect when that point is reached, and then I think the best we can do is to let them slip away from us as peacefully and comfortably as possible. Hospice does a great job doing exactly that.
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