Wednesday, April 6, 2016

Being Mortal, by Atul Gawande

Being Mortal, Atul Gawande's compact book about aging in our modern world, is compassionate and practical. He challenges us to re-examine the ways we end our lives - the ways we force those we love to end their lives - and posits some alternatives to constraints none of us want for ourselves but prove all-too-willing to foist on our elders.

My mom says AGE is an acronym for Aggravating Geriatric Experience. She would know. She doesn't want to be babysat, monitored, checked on, "helped" in her home, forced to eat or drink "the right things" or prevented from sitting alone in her apartment. But the combination of being sedentary and stubborn is untenable. She falls. She gets dehydrated. She forgets. And she's not suffering alone - her refusals impact those who love her, who must rescue her from her choices.

But when we can't take care of ourselves, Here Comes Medicine to keep us alive. We can't see far enough into the future to recognize when to stop. The medical model of dying is a juggernaut of procedures and drugs, and only in hindsight do we know when we should have said, Enough!

Gawande's solution is to ask his patients what activities they love, and the ability to do these things becomes his yardstick for the value of treatment. A man whose joy derives from watching football on TV and eating chocolate ice cream, can weather paralysis of his legs. But if being able to walk is what keeps him ticking, paralysis is unacceptable. That's where I draw the line.

Or so we might say, when we're able-bodied, at a remove from death. As we draw nearer, it's common to discover that being alive, hearing the voices of loved ones, touching them, seeing the sunrise, make that earlier line easy to cross. Well, I can't walk, but I can still -- And so we trap ourselves. Medical advances allow us to pass one limit after another, until we lack the awareness to say I've gone too far. 

This book, powerful as it is, addresses physical not mental debility. In my grandma's final year she was senile, though physically intact. We were close, and all my life I'd known she never wanted to be without her mind. I had a very strong urge to put a pillow over her face and hold it there until her body quit. She would have thanked me. I knew I must not do that, so I didn't, but I still think I should have.  And I hope someone will help me check out, before I'm at the mercy of too much treatment.

1 comment:

  1. Gawande is an excellent writer and has so much of the compassionate insight I find providers either lack or refuse to open up about. The medicinal solutions mean nothing if the quality of life they afford someone is laying in a bed, being rolled daily to prevent gravity from breaking the skin on their backside. This is on my shelf, I can't wait to read it.