Whether futile, end of life medical treatment is driven by the desperation of patients, their families, or by doctors who cannot negotiate the hard conversations—author Dr. Atul Gawande is questioning the benefit and the cost of such denial. In an exploratory tone, Dr. Gawande examines the American approach to aging and death from both the physicians’ and the patients’ viewpoint. He chronicles his own maturation as a doctor through numerous case histories of patients and their decision-making processes as well as the final journey of his own father. Since modern medicine can do astonishing things, he acknowledges some of us have come to treat death as an insult or a failure. Medical advances aside, we do remain mortal.
Dr. Gawande is vulnerable yet questioning as he considers the behavior patterns among practicing physicians including himself. While many doctors still prefer the doctor-knows-best model of control, Dr. Gawande admits he tends to resort to the informative model in which the patient has complete autonomy while he supplies medical and technical expertise with multiple alternatives. Sadly, recipients can become overwhelmed and fail to understand their choices. Since medical schools do not train physicians to deal with death, few offer the guidance most patients would prefer. When things get serious, Dr. Atul suggests we have some hard conversations with our doctors and our families to better manage the problems of aging and preparing for the end of life. This compassionate author values life and the gift of choice enough to identify the 5 difficult questions we need to ask ourselves or those we love when the doctors do not.
- What is my understanding of what is happening to me?
- What are my fears if that should happen to me?
- What are my goals if my condition worsens?
- What trade-offs am I willing to make, or not willing to make, to try to stop what is happening to me?
- What does the range of time look like for people to reach this final point, both with treatment and without?
The author is compassionate and analytical as he considers what he has observed among terminal patients including his own father. We are all mortal, but few of us seem to have considered how we will handle either the aging or the dying process. By not doing so, we seem to be missing a crucial opportunity to adjust ourselves. It’s perspective, not age, that matters most. . . A sense of mortality reorders our desires. (p.99) Although Dr. Gawande writes his book in an exploratory tone, his conviction is revealed in the following quote about his father’s journey. We witnessed for ourselves the consequences of living for the best possible day today instead of sacrificing time now for time later. (p. 229) Often comfort care provokes a rallying, renewed energy that fosters interaction.
However, Dr. Gawande also observes that people sometimes endure miserable side effects from experimental drugs because their people want them to try everything. Fearful family members are unwilling to admit there is a time to die, and this is it. By considering the dying process ahead of time, you can inform your family of your preferences. When the time comes, they will be better prepared to help you manage your aging and your dying.
This stimulating book, Being Mortal, invites introspective thought as well as some liberating but hard conversations with those who love you. Our ultimate goal, after all, is not a good death but a good life to the very end. (p. 245) While Dr. Gawande does not speak of faith or an eternal hope, he does value life deeply.
John 11:25 I am the resurrection and the life. He who believes in me, though he may die, he shall live.