Medicine and What Matters in the End
This post has been updated July 10, 2021
Atul Gawande, MD, MPH, is a surgeon, writer, and public health leader. He is a practicing endocrine surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard T.H. Chan School of Public Health.
He founded Ariadne Labs, a joint center for health systems innovation, and Lifebox, a nonprofit organization making surgery safer globally. He also co-founded CIC Health, which operates COVID-19 testing and vaccination nationally, and served as a member of the Biden transition COVID-19 Advisory Board.
Dr. Gawande writes for The New Yorker magazine and has written four New York Times best-selling books. He won two National Magazine Awards, AcademyHealth’s Impact Award for highest research impact on healthcare, a MacArthur Fellowship, and the Lewis Thomas Award for writing about science.
In 2021 he delivered the commencement address at Stanford University , from which he had graduated. In his speech he referenced the COVID-19 pandemic, calling it the third highest cause of death in 2020. He also told the graduates,
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In Being Mortal, he explores the way most people now live, age and die and for the most part it’s not a pleasant prospect.
How we care for elderly people
As people age and lose independence due to frailness, illness, mental decline and poverty, they often also lose whatever is most important to them- their home, pets, hobbies, possessions. And these losses often occur to protect them from harm as they progress into assisted living centers, nursing homes and hospice.
Dr. Gawande describes how his family in India expected to care for their elderly relatives, which differed from what he saw happen when they immigrated to the United States. After becoming a physician, he recognized that our care of the elderly often robs them of the well-being that he sought to promote in his practice.
He wondered how it can be done differently. To find out, he interviewed people who are developing novel ways to provide care to older people, care that preserves their independence, dignity and choices while still keeping them safe and protected.
Most of us either have relatives or friends facing these decisions, or are facing them ourselves. If not now, we all will eventually. Whichever the case, this book shows
“how the ultimate goal is not a good death but a good life-all the way to the very end.”Atul Gawande
How we care for dying people
Finally, Dr. Gawande discusses end -of -life care- that is, care when a disease has become terminal and a cure is no longer likely. Sometimes it is difficult to determine when that occurs. As he says, it is rare in medicine when there truly is “nothing more we can do”.
However, just because we can do something, doesn’t mean we should. Some treatments, rather than extending life just prolong the suffering. Still it is heart wrenching for patients and families, along with their doctors, to decide that it is time to forgo treatment and instead opt for palliative care, with or without hospice.
(Palliative care focuses on symptom management and social and emotional support for patients and families.)
Dr. Gawande poignantly describes this process by sharing in detail his father’s cancer diagnosis, treatment, progression, hospice care and death. He shows how difficult a process this can be, given that even he and his parents, all of whom are physicians, struggled to come to terms with the reality of terminal illness and the dying process. Though they were all familiar with and experienced in dealing with the medical system, they still felt unprepared to face the decisions required at the end of life. But in the end, both he and his father felt at peace with the outcome and Dr. Gawande senior did experience “a good life-all the way to the very end.”
I enjoyed listening to this interview with Dr. Gawande-
a podcast interview with Tyler Cowen
In gripping accounts of true cases, surgeon Atul Gawande explores the power and the limits of medicine, offering an unflinching view from the scalpel’s edge. Complications lays bare a science not in its idealized form but as it actually is―uncertain, perplexing, and profoundly human.
The struggle to perform well is universal: each of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives may be on the line with any decision.
Atul Gawande, the New York Times bestselling author of Complications, examines, in riveting accounts of medical failure and triumph, how success is achieved in this complex and risk-filled profession
Atul Gawande shows what the simple idea of the checklist reveals about the complexity of our lives and how we can deal with it.
Here is Dr. Gawande’s speech at the Stanford Commencement
sharing the HEART of health from birth to death
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