Friday, March 27, 2015

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

When I heard about the subject matter for this book, I did not want to read it. I am  almost 63 years old and I have a mother who is 90 years old. So this book strikes home… My father died when I was seven, I have lost my sister, cousins and other family members. I have seen what happens when people die from cancer. So while I read many of the tragic stories of how people died in this book, it does not come as a great surprise to me. What I take from this book is that we all should have options on how to end our life when there is so much pain, no hope…

Listed below are my takeaways from excerpts in the book:

Modern scientific capability has profoundly altered the course of human life. People live longer and better than any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by healthcare professionals. And we in the medical world have proved alarmingly unprepared for it.

This experiment of making mortality a medical experiences is just decades-old. It is young. And the evidence is it is failing.

This is a book about the modern experience of mortality – about what it's like to be creatures who age and die, how medicine has changed the experience and how it hasn't, how our ideas about how to deal with our finitude have got the reality wrong.

The waning days of our lives are given over to treatments that battle our brains and sap our bodies for a sliver's chance of benefit.  They are spent in institutions – nursing homes and intense care units – where regimented, anonymous routines cut us off from all things that matter to us in life.

Old age is not a diagnosis. There is always some final proximate cause that gets written down on the death certificate – respiratory failure, cardiac arrest. But in truth, no single disease leads to the end; the culprit is just the accumulated crumbling of one's bodily systems while medicine carries out its maintenance measures and patch jobs.

Researchers found that loss of bone density may even be an even better predictor of death from atherosclerotic disease than cholesterol levels. As we age, it’s as if the calcium seeps out of our skeletons and into our tissues.

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. Although the elderly population is growing rapidly, the number of certified geriatricians the medical profession has put in practice has actually fallen in the United States by 25% between 1996 and 2010.

Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

Certainly, suffering at the end of life is sometimes unavoidable and unbearable, and helping people and their misery may be necessary. Given the opportunity, I would support laws to provide these kinds of prescriptions to people. About half don’t even use their prescription. They are reassured just to note they have control if they need it.

No comments: