“Being Mortal – Illness, Medicine and What Matters in the End” by Atul Gawande – A Book Review

We all have limited lifespan. One day we have to face death. We may not want to talk about it as it is depressing. But this is important when we live long enough into retirement. It can be part of our retirement planning also. We make our choices while we are still healthy and make them known to our loved ones so that they do not have to agonise about making decisions for us when serious illness hit us.

“Being Mortal” a book written by Dr Atul Gawande is a book I would recommend.

Dr Atul Gawande is a medical doctor and also a Professor at Harvard Medical School. In most cases, people do not want to talk about serious illnesses, about end-of-life medical care and about dying. It is to be avoided as far as possible until we face it ourselves or our immediate family members were hit by a debilitating illness. Then we scramble to cope with many decisions. Should we cure at all costs even with miniscule success rate? What kind of medical care facilities to go for palliative care? Do we know what is best for the chronic sick?

“Being Mortal” is a very readable book. It is written from the perspective of a doctor caring for patients. Atul Gawande related several medical cases intimately in the book like mini stories. He also shared his father’s journey to the end.

What did I learn from reading this book?

Independence and dignity
We have been independent for most of our lives. It may come a time we have to depend on carers and medical staff when we fall real sick. The choices for where the elderly sick should go to stay are on a continuum of complete independence to surrendering independence.

The choices include:

  1. Continue to stay at own home (independence in place)
  2. Assisted living facility (stay in home-like environment with medical support)
  3. Retirement community with common medical facility (subset of assisted living)
  4. Nursing home (regimented facility, forgoing independence)
  5. Hospice stay

The choice entails costs of medical care. For example, assisted living facility is more expensive than nursing home. If one can afford the costs, independent living provides dignity and higher quality of living.

Hard conversations
When faced with serious illness, such as cancer, most times patients surrender their choices of treatment to their specialist doctors. With the progress of the illness to the end-stage, patients are subjected to choices that may not accord to their wishes. Doctors are good at treating diseases and sometimes neglected what the patients want.

Do we really have hard conversations with our loved ones? Do doctors ask them these questions instead of just treating the disease?

  1. What is your understanding of the situation and its potential outcomes?
  2. What are your fears and what are your hopes?
  3. What are the trade-offs you are willing to make and not willing to make?
  4. What is the course of action that best serves this understanding?

(credit to the author)

It is very important to hold a conversation with your loved ones on end-of-life choices. You may then know whether they want to be kept alive with all the life sustaining machines when there is no hope of recovery.

At the end of the day, can the patient let go and also for the family members to let go of their loved ones when the time comes to say the final farewell?File_000

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