I can't remember how I learned about American surgeon Atul Gawande's Being Mortal (probably a Facebook discussion), but it is a remarkable and thought-provoking read. Sub-titled Illness, Medicine and What Matters in the End, Gawande's book begins by discussing the advances of old age, and how to rethink what makes the end of life good, rather than just longer, and then moves into talking about terminal disease and similar issues there.
As a doctor, Gawande admits that he has often slipped into the role of 'Dr Information,' laying out treatment options, risks, benefits, side effects etc, and telling the bewildered, stressed patient to make a choice. Very few of us are well equipped to weigh up our options accurately, or even know what questions to ask, in such a situation. After observing skilled hospice and palliative care workers, Gawande has changed his approach, to ask what is most important to each individual patient -- prolonging life? Staying active? What would they be unwilling to trade off? What would make life no longer worth living? For one patient, being able to enjoy chocolate ice cream and watch football might be enough. Another might be unable to endure the risk of paralysis, or invasive medical treatments, or a greater level of pain. Gawande can then help the patient decide what approach is best for them, rather than just offering another treatment possibility, then another (there is always another treatment to offer).
With two elderly parents approaching the end of their lives and a friend in their final days, this felt like a particularly timely read, and one which has prompted me to think hard about what I want for myself in my last days. It's also made me determined to talk about this openly with my loved ones and not shy away from the difficult conversation. As Gawande points out, 'hard conversations can make wonderful things possible.' But it also makes my heart ache, because it's impossible to have this kind of nuanced conversation now with my father, because he just can't communicate with us well enough. I think I have a pretty good idea of his wishes now, but he can't spell them out for us in any detail. Don't leave it too late.
I wished I had read this book earlier too, Kate. I could have had much more honest conversations with my mother about her care; I could have discovered what she wanted, rather than doing what I thought she wanted. Still, we did the best we could. I feel that the conversations around death and dying, medical interventions and pallative care are becoming more and more open, which can only be a good thing.
ReplyDeleteYes, I think you're right. Oh! I think I might have remembered where I heard about this book now, it might have been in the bibliography of The Believer -- certainly the section in that book about the death doula and now Gawande's book have both been really thought-provoking. And yet these conversations are still so hard.
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