Lately I have been hearing the buzz surrounding difficult conversations about the decisions that we each must make at the end of life inspired for many by the book by physician Atul Gawande. Many families, villages, faith communities and book groups have been using his book as a way to launch into the much needed conversations with loved ones. Muriel Cole of Home Ports a Village in Chestertown, Maryland that serves all of Kent County shares this article she wrote that was published here as a reprint with permission from the Kent County News.
Peter Franchot, Maryland Comptroller, was asked to address a legislative rally in late January organized by United Seniors of Maryland. He walked up to the podium and held up a book.
“We are missing our mark with seniors,” he said. “I’m appalled at how our medical system treats them.” Citing his recent experience in helping his elderly parents, he said, “Older people want to live with dignity and independence. It’s a travesty and an economic travesty. Read this book!”
The book he was speaking about is “Being Mortal: Medicine and What Matters in the End”, by Atul Gawande, a practicing surgeon at Brigham and Women’s Hospital in Boston.
I was in the audience for Franchot and a lot of other dignitaries that day at the State House in Annapolis and was breathless that he would bring up this book. It’s one of the most thought-provoking books that I have read in a long time. After he left the podium, my hand flew up and, uncharacteristic for me, I ran up to the front and, in front of 300 people, begged everyone to get it and read it.
Medicine has limitations and failures, especially at the end of life. Most of us, including physicians apparently, find that hard to face and hard to talk about. Gawande wants Americans and the health care establishment to be more open and honest about medicine’s capabilities. “We should never sacrifice what people really care about,” he thinks.
Gawande gives an easy-to-read, concise summary of how medical care for seniors has evolved in this country and the societal context. Using examples of family and friends who have lived to old age, he describes the 21st century situation that many face— the frequent falls resulting in hospitalization, other obstacles, trade-offs, and end -of-life medical treatments that we might not personally choose if we were able to decide.
Gawande says, “You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit.…Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by … medicine, technology, and strangers.” Whew.
Gawande emphasizes the importance of listening to what people want. What are our priorities?
“If to be human is to be limited, then the role of caring professions and institutions— from surgeons to nursing homes— ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But 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.”
The Washington Post named it one of the ten best non-fiction books of 2014.
Perhaps his message can best be summed up with his view that “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. And well-being is about the reasons one wishes to be alive.”