A few years ago, my beloved sister in law (Charro) sent me a surprise gift, a book,
Being Mortal by Atul Gawande. Charro is from Palo Alto, CA and is a nurse oncologist. She worked at Stanford University Hospital doing cancer research for a number of years. She just retired recently.
I read the cover page of the book and it sounds very interesting being a
senior citizen. However, when I opened the first chapter, the font of
the book is small, I could hardly read it. So I did an Internet search
and here's an excerpt from the review of SHERI FINK dated NOV. 6, 2014,
published in the New York Times. I recommend this book to all senior
citizens of the world. Thanks again for your gift, Charro.
"It began with a tingle in the surgeon’s fingers and a pain in his neck.
A couple of years later, he learned he had a tumor inside his spinal
cord. That was when the difficult choices began. Should he have it
removed right away in a risky operation, as his doctor recommended? Or
should he take time to consider this question: At what point would the
expanding tumor cause debility bad enough to justify the risk of greater
debility or even death in trying to fight it?
The surgeon in the story is the father of Atul Gawande, who is also a
surgeon as well as a writer for The New Yorker. His new book, “Being
Mortal,” is a personal meditation on how we can better live with
age-related frailty, serious illness and approaching death.
Medical professionals are the ones who are largely in control of how we
spend our “waning days,” he writes, yet they are focused on disease, not
on living. “Medicine has been slow to confront the very changes that
it has been responsible for — or to apply the knowledge we have about
how to make old age better.” The experts quoted here argue that doctors
should not only treat disease but also concern themselves with people’s
functional abilities, and that most medical trainees should learn about
geriatrics.
In the first part of the book, Gawande explores different models of
senior living — from multigenerational households to newfangled nursing
homes. In the latter part, which is shorter, he shifts somewhat abruptly
to end-of-life medicine, promoting hospice as a model of care. The two
sections are anchored by two of Gawande’s most memorable New Yorker
essays, which make up two of the book’s eight chapters — “Things Fall
Apart” and “Letting Go.” Around them are rich stories from his own
family.
“Being Mortal” is a valuable contribution to the growing literature on
aging, death and dying. It contains unsparing descriptions of bodily
aging and the way it often takes us by surprise. Gawande is a gifted
storyteller, and there are some stirring, even tear-inducing passages
here. The writing can be evocative. In a home for the aged in a New
Delhi slum, mattresses are “pushed up against one another like a large
sheet of postage stamps.”
The stories give a dignified voice to older people in the process of
losing their independence. We see the world from their perspective, not
just those of their physicians and worried family members.
One of his most provocative arguments is that hard-won health and safety
reporting requirements for elder care facilities might satisfy family
members, but ignore what really matters to the residents in question.
Despite the popularity of the term assisted living, “we have no good
metrics for a place’s success in assisting people to live,” Gawande
argues. A life of safety isn’t the life most people really want for
themselves.
Gawande searches for models of care that promote frail people’s ability
to live a meaningful life, by imbuing them with cause or promoting their
ability “to keep shaping the story of their life in the world.” The
reader may wonder if everyone in these innovative senior communities is
as satisfied as the individuals Gawande profiles. Given that there is
little data to back up the anecdotes, it’s hard to know if there are
real solutions here. There is also relatively little exploration of the
options for people with dementia.
In the last part of the book, Gawande argues against the
treatment-at-all-costs model that once prevailed in medicine. “People
with serious illness have priorities besides simply prolonging their
lives,” he writes. “If your problem is fixable, we know just what to do.
But if it’s not? The fact that we have had no adequate answers to this
question is troubling and has caused callousness, inhumanity and
extraordinary suffering.”
Gawande is swayed by the paleontologist Stephen Jay Gould’s essay “The
Median Isn’t the Message.” After receiving a cancer diagnosis with a
median survival of only eight months, Gould observed that some patients
survived well beyond the eight month median. He became one of them,
living some 20 years after experimental treatment, and dying from an
unrelated cancer.
Gawande uses his father’s powerful story to explore the concept of
shared decision-making in medicine — the idea that the ideal modern
doctor should be neither paternalistic nor informative but rather
interpretive, helping patients determine their priorities and achieve
them. He shares lessons he learned from a palliative care doctor who
advises him to “ask, tell, ask” during a difficult discussion about a
patient’s prognosis: Ask what patients want to hear, tell them and then
ask what they understand.
Gawande identifies no perfect solutions to the problems inherent in
bodily decline. He is just asking us to commit ourselves to creating
better options and making choices with the goal of a purposeful life in
mind ".
About the Author: Atul Gawande has been a staff writer for The
New Yorker since 1998. He is the author of three best-selling books:
“Complications,” a finalist for the National Book Award; “Better,”
selected by Amazon.com as one of the ten best books of 2007; and “The
Checklist Manifesto.” His latest book is “Being Mortal: Medicine and
What Matters in the End.” He has won the Lewis Thomas Prize for Writing
about Science, a MacArthur fellowship, and two National Magazine Awards.
He is also a surgeon at Brigham and Women’s Hospital, in Boston, and a
professor in the department of health policy and management at Harvard
School of Public Health and in the department of surgery at Harvard
Medical School. He is the executive director of Ariadne Labs, a joint
center for health-systems innovation, and the chairman of Lifebox, a
nonprofit organization making surgery safer globally.
Meanwhile, enjoy this photo of my orchid in bloom inside the House!
