Being Mortal- a book review

a book review – Being Mortal -Medicine and What Matters in the End by Dr. Atul Gawande

Being Mortal 

Medicine and What Matters in the End

by Atul Gawande, M.D. 

(This blog post features affiliate links which pays a small commission to this blog from purchases, without additional cost to you)

 

 

Dr. Atul Gawande is a surgeon at Brigham and Women’s Hospital in Boston, Massachusetts and professor at Harvard Medical School. He writes for The New Yorker and has authored three other bestselling books.

He also (in June 2018) was named  CEO of the Amazon-Berkshire-JPMorgan Chase healthcare partnership, causing some to call him the “most feared CEO in healthcare.”

 

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.

Caring 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.”

woman sitting in a cemetery
photo from the Lightstock.com collection, an affiliate link

Caring 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.”

Being Mortal is also available as a convenient low cost ebook from eBooks.com. (Using this affiliate link supports this blog.

drawing of various electronic devices-phone, PC, tablet,
graphic from Lightstock.com, an affiliate link

 

I  also enjoyed listening to this interview with Dr. Gawande-

 Atul Gawande on Priorities, Big and Small– a podcast interview with Tyler Cowen

Other books by Dr. Gawande

Complications : A Surgeon’s Notes on an Imperfect Science

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.

 

 

Better: A Surgeon’s Notes on Performance 

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

The Checklist Manifesto:How to Get Things Right

Atul Gawande shows what the simple idea of the checklist reveals about the complexity of our lives and how we can deal with it.

 

I appreciate your sharing  this post on your social media pages.

And please follow Watercress Words for more information and inspiration to help you explore the HEART of HEALTH.

Thank you for  viewing  the advertisements and using the affiliate links  that fund this blog; with your  help, we can grow, reach more people, and support worthy causes that bring health and wholeness to people around the world.

Thanks for visiting.        26952564_10213093560871954_4239554644472378905_o

Dr. Aletha 

Being Mortal- a review

a book review – Being Mortal -Medicine and What Matters in the End by Dr. Atul Gawande

Being Mortal 

Medicine and What Matters in the End

Atul Gawande- Being Mortal-book cover

 

 

(This blog post features affiliate links which pays a small commission to this blog from purchases, without additional cost to you)

 

I read Being Mortal by Atul Gawande, M.D. (To be exact, I listened to the audio version)

Dr. Gawande is a surgeon at Brigham and Women’s Hospital in Boston, Massachusetts and professor at Harvard Medical School. He writes for The New Yorker and has authored three other bestselling books.

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.

Caring 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.”

 

woman sitting in a cemetery
photo from the Lightstock.com collection, an affiliate link

Caring 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.”

 

Atul Gawande on Priorities, Big and Small– a podcast interview with Tyler Cowen

 

Other books by Dr. Gawande

Complications : A Surgeon’s Notes on an Imperfect Science

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.

 

Better: A Surgeon’s Notes on Performance 

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

 

The Checklist Manifesto:How to Get Things Right

Atul Gawande shows what the simple idea of the checklist reveals about the complexity of our lives and how we can deal with it.

 

I appreciate your sharing  this post on your social media pages.

And please follow Watercress Words for more information and inspiration to help you explore the HEART of HEALTH.

Thank you for  viewing  the advertisements and using the affiliate links  that fund this blog; with your  help, we can grow, reach more people, and support worthy causes that bring health and wholeness to people around the world.

Thanks for visiting.        26952564_10213093560871954_4239554644472378905_o

Dr. Aletha 

How do you want to die?

If, like me, you don’t listen to rap often, you may need to watch this video more than once to get the message. Dr. Zubin Damania, aka ZDoggMD, is a “physician, off-white rapper, and purveyor of the finest medical satire.” In this video and others he uses unconventional means to educate and inform about important health issues. This video caught my attention and I hope it does yours also.

We, meaning doctors and patients, care much about how we live, but often give little attention to how we die. But death, after birth, is the single thing we all share as humans. Still, we live like it’s not going to happen, or act surprised when it does.

 

Fewer than 10% of persons with sudden cardiac arrest survive.
Fewer than 10% of persons with sudden cardiac arrest survive.
Death should never be welcome, and it will never be easy, but sometimes it is more horrible than it has to be because no one planned for it. No one asked the hard questions-

“What if you are diagnosed with a terminal illness?”

“What if you can no longer swallow or eat on your own?”

“What if you cannot breath unassisted?”

“What if you are no longer competent to make your own medical decisions?”

 

End of life planning is not synonymous with ending care or euthanasia. It is about providing comfort, controlling pain and other symptoms and supporting family. It’s about deciding ahead of time how you want to spend the last few months, weeks, days or hours of your life.

End of life care is often provided through hospice services. 

No matter how young or old you are ,it is important to consider these things, because unexpected illness and injury can happen to anyone. There are two things to do-

 

Talk- to your family about what you want. If you  already have a life threatening condition, talk to your doctors.

Write- down what you want. This is usually in the form of an advanced directive, living will or medical power of attorney. You can learn how to do this here.

 

Advance directives are discussions or written statements which convey a person’s wishes to his or her family and physician in the event that he or she becomes unable to discuss such matters. They may

1. explain the individual’s values about health, life and death;

2. give directions to family and physician about treatment goals or the use or non-use of specific treatment modalities; or

3.  designate a surrogate to make decisions on behalf of the individual.

After completing an advance directive, the individual should discuss its content and meaning with his or her family, surrogate, and physician. Individuals should review their advance directives periodically to assure that they accurately reflect their current values and wishes.”(CMDA Ethics Statement)

My husband and I  have advance directives,and we discuss our wishes with each other periodically to confirm what our current  plans are. We both prefer to forgo aggressive treatments which are likely to be futile, but you may feel differently; it is important for your family to know.

 

 

 

It is also important to understand what your physician thinks and believes about end of life care, and how those beliefs affect one’s medical practice. Ideally, you and your doctor will agree on expectations and if not, it may be best to seek care elsewhere.

 

“Clinicians should examine carefully the verbal and written wishes expressed by their patients. They should be willing to follow these wishes provided they do not conflict with the clinician’s personal moral or religious values. If such a conflict exists, the clinician should discuss it with the patient and transfer care if the conflict cannot be resolved. ” (CMDA Ethics Statement)

 

 

“It always seems too soon until it’s too late. Talk about your end of life wishes now with those you love.” ZDoggMD

 

For further reading-

 How Doctors Die

Advance Directives and Do Not Resuscitate Orders.

 

“The End-of-Life Handbook” A Compassionate Guide to Connecting with and Caring for a Dying Loved One

(an affiliate link which pays this blog a commission for your purchase; thanks)

“This book address both the emotional and psychological issues associated with death and dying and the practical and medical realities typically dealt with at this time-unusual among titles in this subject area.

The authors, a psychologist and medical doctor, are passionate advocates for quality end-of-life care. Author Feldman’s background in positive psychology brings an emphasis on hope, inspiration, meaning, and human connection at the end of life to the book.

As medical technology progresses and life expectancies edge upward, families are being faced with ever-more-complicated choices as loved ones approach their final hours. This book offers readers much-needed guidance and support for making these often difficult decisions.”