Thursday, April 01, 2021

Being Mortal: Medicine and What Matters in the End by Atul Gawande

This book was recommended to me by several people.  With my parents both on the cusp of 90, they said it was a great read to help us navigate the medical and senior system.  Though written by a U.S. doctor there are plenty of take aways for a Canadian too.  

The author takes a hard look at aging and what used to happen and what now happens in America in the post modern, indrustrialized society.  Our attitudes and focus have definitely taken a shift over the century from all viewpoints:  the medical field, the aged themselves and those coming up behind who are to care for their loved ones.  The author presents the idea that what medicine created in allowing longer lives has not kept up on the end of serving it's end of life citizens well, whether they are end of life through aging or or through illness.  

"Medicine has been slow to confront the very changes it has been responsible for - or to apply the knowledge we have about how to make old age better"
pg. 16

As medicine has allowed for longer lives, for the aged and the infirm, there has become more aged and less doctors who want to care for the aged.  The author points out the fact that there is no money to be made working with the aged, no challenge but to hear their regular complaints of bodies no longer working the way they used to.  Most medical students are opting for specializations that are exciting, more glamourous and making them money for their efforts.   This is not found in the caring for the aged.  As he goes through various cases he has dealt with, including his own father who faced a rare and debilitating cancer, he started to ask "What makes life worth living when old and frail or unable to care for ourselves".    He explores how medicine in it's concerns with extending life have run opposite to what might make living worthwhile for each individual.  Doctors approaches have become an "information dump" onto patients so that they can know their choices not ever pausing to ask what are the patients desires and goals for outcomes.  What do they individually want and not want, what is the goal for them.  It is as individual as each person.  And it is this that is missing in our care of them.  The author argues that quality of life for each individual should be the desired goal and doctor/patient decisions should be made upon those expressed ideals.  

"When to shift from pushing against limits to making the best of them is not often readily apparent.  But it is clear that there are times when the cost of pushing exceeds it's value" 
pg 262

This was an eye opening book as the author made his arguments through real life stories and his experiences as a surgeon.  His explored the various approaches that different medical disciplines take and how doctors need to take more time to really get to know their patient and what it is they really want.  His arguments for "finding the quality of life" and living the best possible day today  are laid out in an easy to read language and he encourages us to ask the hard questions of our loved ones before they are not able to communicate what is quality of life to them.  What do they want to sacrifice now for time later and what do they not?  What do they want out of their last days?  What are their fears?  We should not assume we know and we will probably be surprised by their answers.  He argues that when we ask these hard questions it helps both the individual and those who care for them (professionals and family) to be able to make the confusing, hard decisions when we are faced with them.  He advocates for quality hospice care  so that a person's last weeks or months may be rich and dignified according to their own goals of end of life.  

"...the role of caring professions and institutions...ought to be aiding people in their struggle with those limits.  Whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life."
pg 260

"We've been wrong about what our job is in medicine.  We think our job is to ensure health and survival.  But really it is larger than that.  It is to enable well being".
pg ??

"Our ultimate goal, after all, is not a good death, but a good life to the very end"
pg. ??

(??  I forgot to take note of what page these quotes were on)

I gave it a 9.5/10   Well worth the read!


Barbara Harper said...

I read this a few years ago and found it quite eye-opening, too.

netablogs said...

I read this a few years ago, too, and I heartily recommend it, as well. It reminded me that elderly people don't primarily want to be safe, they want to LIVE and have a life of meaning till the end. Great post!

Faith said...

wow quite eye opening!!

I do know that I firmly believe the nursing facility we put my dad in druggedh him up too much for his supposed dementia. We didn't have money to pursue a lawyer and he's with Jesus now so doesn't matter but we kind of wish we had gone in with a detective type person or lawyer to really see what was going on. NOT good. This book just shows me that living a life with a plant based diet is going to be vital for staying healthy into old age. and traditional doctors do NOT like the use of essential oils and natural remedies like plants because guess what?? it takes away from big pharma. My doc was SHOCKED when i told her i was refusing a statin to bring down my LDL cholesterol. I chose to take plant phytosterols and guess who's cholesterol came down from 216 to 178?????? she was shocked and now admits this is a better alternative to spending money on a prescription every month.

Wendy said...

Sounds like an interesting book.

Unknown said...

Faith: This book very much advocated having those conversations with doctors and family so that they know how to proceed if and when things happen when there is so much information overload and hard choices that the person is overwhelmed and confused as to how to proceed. He is very much on the side of knowing when enough is enough with medical interventions that might or might not work and actually end up reducing the quality of life that they are trying to make better. And I think I read somewhere that this doc is now on Biden's COVID team of advising doctors? Don't know how true that is though.