Medicine and the End of Life: "Being Mortal"
This week I went along the Bangalore launch of Atul Gawande’s book Being Mortal. This is a book about the time towards the end of our life. Historically, and in most societies still, people live their last days at home, and eventually die at home. One likes to think this occurs with them surrounded by their children, in familiar surrounds, in control. In an earlier time, medicine didn’t have much to offer the old and the infirm, so hospitals and doctors only had a marginal role to play.
Now, 83% of Americans die in institutions. The most likely time in the US to have a surgery is in the last week of your life – a miserable last week. This over-medicalization of old age leads to people getting distracted from their own priorities and interests. They keep pushing for the next operation or procedure or medication that will prolong living (and provide hospitals with profit) – forgetting what it is they actually live for.
I have just reached a point in my life where myself and my friends are dealing with our parents’ generations’ mortality – open heart surgery, minor and major cancers, tests for early onset of Alzheimers, depression, the first falls. Things are starting to fall apart.
My first inclination is to shy away from these issues and buy expensive youth enhancing face cream – my own parents are fine right now, and I prefer to imagine they will always be fine.
But this book has the pull of inevitability – I feel a macabre and dutiful attraction.
I really enjoy Atul Gawande’s writing, he is a surgeon but also a good thinker. Checklist Manifesto is on my list of Most Inspiring Public Health Books. As he says himself, he uses writing to think through how to do things better, and how to be a better person. He considers questions of how you succeed and fail, and how you really learn – not from textbooks but from your own experience. He does a great job of getting the reader to come along with him as he thinks an issue through – and as a reader you almost feel a sense of triumph, like you figured it out with him (nice!).
This book is based on hundreds of interviews with doctors, nurses, caregivers and patients about how we can do this – that is, getting old and dying – better. I like that we find the solution through humble little stories, nicely curated.
And how do we die better? I am only half way through the book, so I can’t share the ending. But I can say that I thought this was a terrible topic for the holiday season, this is the last thing anyone wants to think about at Christmas – but it’s hopeful! And happy! As good a gift as face-cream.