January 21

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


Gawande, a Boston surgeon, writes a thoughtful book about how we live our lives, up to the end.  He argues for lifestyles that avoid the boredom, loneliness and helplessness that often fill the last days of many elderly or terminally ill individuals.  He describes the ways our bodies "fall apart" either through the wear and tear of aging or through serious illness.  He also laments that fewer doctors are socializing in gerentology than ever before - and that people are living to much older ages - resulting in a graph he terms the rectangularization of survival rather than the triangle of survival (e.g., as many people alive at the older spectrum as at the  younger).  He recommends asking the crucial questions (DNR? Intubate? etc) before the patient is in a position to need them.  Older folks' first priority is not safety (as their children seem to think) but living a worthwhile life - not necessarily living in a place where there's a computer lab or an exercise center or (toward the end) a bed in a shared room where the time they eat, turn off the lights, and go to the bathroom, is dictated by the convenience of staff.  Each situation is different, but by asking the hard questions and the practical questions ("What's most important to you now?" e.g., to die at home, to avoid pain, to live a full life now rather than sacrifice comfort now for chemotherapy/surgery in the hope of prolonging life later), we may make life more meaningful for our loved ones, and ourselves.

I read this book the year before my mother died, and Gawande's ideas and examples of people living independently or living with family (rather than in institutions) made me rethink what I was trying to persuade my mother to do, that is, to live in a facility that would provide safety and social activities.  Mom got her wish, though; she continued to live in her home independently almost until she died (during rehab for a knee replacement).