Dispatches from the 148 by Fred Ryan
Dispatches from the 148 by Fred Ryan
Actually, I’d like to see all doctors – OK, everyone – read this book. As for my own physician, one of the best, he already knows this topic well and has been through this battlefield many times. The book is “Being Mortal: Medicine and What Matters in the End” by Atul Gawande, an American surgeon who is a humane and accomplished writer.
The book is headline news for the generation sandwiched between raising children and caring for older parents. And helpful for anyone ageing – which would be all of us. Gawande’s message is simple: what we don’t talk about now will come back exactly when we are least able to talk about it, when we’re faced with major, life-threatening decisions. When your suddenly-paralysed mother is found to have a mass pressing her spine, that’s late to start the discussions.
Another message here: hope is not a plan, and yet it is what most of us have as
our end-of-life plan. We rarely picture our deaths, and, when we do, imagine it coming quickly, painlessly, and decisively. However, most deaths in old age are not quick nor painless, and drag on.
Given our ageing population and our tight families, this subject is Pontiac-relevant. Seniors’ numbers are growing, needs for care and interventions are growing; we easily picture ourselves facing these issues for our parents and,
ultimately, for ourselves. A perfect book for autumn, in other words.
Bookstores used to promote self-help books on youthfulness, sexual vitality, personal care and beauty, careers and success, family skills, educational success. Books on dying sold less well, presumably.
We still avoid the topic. Thinking about death and dying seems morbid and maybe a little self-defeating. Yet reading the examples in Gawande’s book and seeing the struggles many families around us are facing, avoidance is not a wise move. Woody Allen said he didn’t fear death, just the dying part – and that’s probably true of us all. We don’t want to think about dying, but when we do, we certainly want to avoid pain and lack of functions, loss of privacy and mobility; we fear losing memory, hearing, muscle tone, even our balance; we know we will miss not our possessions and investments, but our family members, our close friends and our personal way of life. Surveys of those nearing the end of their lives cite exactly these things as what is of value to them.
Most important, what is not of prime value to them is just “existing”.
Few people near death want quantity over quality of life. But many of us, says Gawande, see our own ends in drastically unrealistic terms – we err massively on optimism. Surgeon Gawande, responsible for many of the situations he now dissects, describes a senior with a permanent tracheotomy, feeding tubes, dialysis catheter, laying in a technical bed, tethered by the tubes and lines as much as by any belt, drifting in and out of consciousness, surrounded by sterile, blinking and beeping equipment. Yet, example after example, people end up in that situation – partially because they did not consider even its possibility (nor their options) before being faced with an urgent crisis.
Gawande describes the economics and politics of nursing homes, assisted living, all the categories of care facilities; he discusses the perspective we take in evaluating these: the patient’s wishes or the children’s resources, especially the system’s offerings. All familiar topics, and brought much closer to home with his real-life examples.
Being Mortal is not a traditional self-help book; it advocates, rather than instructs, although Gawande has sage advice for individuals: as we age, we should focus on all that we do, avoid auto-pilot reactions; we should struggle to define and maintain a purpose in our own life (simple, like being of service to others or even to express our conclusions gained over a lifetime). Rather than wait the ten years, which will be here tomorrow, we should pay attention now to how we will likely live toward the end, pay attention before we need help, and use all these considerations to talk frankly to those close to us, our parents, kids – and our doctor.