Monday, January 2, 2017

Atul Gawande's book "Being Mortal"


I have just finished reading Atul Gawande's book "Being Mortal". It's an important book for all of us to read. It talks unflinchingly about death, dying and making the decisions necessary to ensure a good end.
Some of the stories he told in this book were heart breaking especially the story of his own father's death. I had got to know Dr. Gawande's father in a previous book "Complications" and to read of the progression of his cancer was unbearable.
It's hard to imagine how Dr. Gawande wrote this section of the book out.
There were useful parts in this book for both doctors and caregivers of the dying. We have to prepare ourselves when we have sick family members to do the right things by them rather than what we would have them do. It's important to recognize that we need to ask the right questions. These questions should ask the dying what they really want, what they feel is a good end and such like. I haven't had the courage to work on this end of life business with any family member. I don't even know what the end of life decisions will be in my own case.
It's a book that I will read again and try to think about in small steps. My focus has been throughout my life to try to save everyone and worry about the rest of the problems later. Now I want to sit in a quiet space and think about dying and what it means. It means a lot of courage I think. it means facing the horror of death for even a good death has the dying moments of the loved one which may go on for a long time. It means doing things that I haven't thought about that I am now thinking about. How does one do the last part of life? Does one stay at home? Does one go to the hospital in a hospice program? Does one die fighting for one's life in an ICU ward in a hospital? When is enough really enough?
When does one decide that the repeated efforts to try to stay alive aren't worth it? In our modern age, we can do the repeated efforts to prolong life for a great many times (well as long as doctors don't try to do the premature termination business). I think the most important thing I got out of this book was about respect. Doctors, caregivers and the family must respect the wishes of the dying. If the dying person wants to keep trying to live then we must respect this especially those doctors who do not feel that such a life is worth living. We can't decide for anyone what is a life that is worth living. When someone wants to stop with the resuscitation we have to respect this as well. It's no use trying to keep alive a shell that wants to break out of the shell.
What is comforting in the book is that we are moving (by ourselves) out of the prescribed ways of death into our own ways of death. We are deciding on care at home. We are thinking of hospice care at our homes. We are making our own good ends.
There was some important information in the book about one cause of falls. Seniors can fall due to postural hypotension. Apparently the body can't maintain enough blood pressure when folks change position from sitting to standing for example and they fall. There is no cure. You just have to guard folks. This may be happening with folks who just are fine one minute and on the floor the next minute.Dr. Gawande describes on page 84 that there was this patient Lou who would be standing and then pitch forward due to this condition. Very scary.
Some interesting solutions to the problems of nursing homes which are BLH--boredom, loneliness and helplessness. You gotta give folks something to do -and pets seem to help.
Perhaps the most poignant part of the book was the matter of perspective shifting as you get to old age and dying. The old want to be with their loved ones, the young with new people rather than the dying mother. It's clear that as you get older the closest ties matter; this might be the reason why mum is so clingy. Her world is narrowing and my world is still wide. Very easy to remedy--you just have to be with the folks with the narrowed world.
A very good book. Worth buying and reading for its counsel. Dying is hard but we all have to do it. And we can do it well by facing it and planning it. I don't know if I am able to talk about these matters with my parents or really with myself but it's a start to just read this book. And reread it.

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