Tuesday, August 25, 2015

"Being Mortal"

This well known and widely praised book by physician and New Yorker magazine writer Atul Gawande had been circled around here for maybe eight months.  I guess, like many of the patients, family members, and doctors described in the book there was not an inclination here to read or talk too much about death.  Then a good friend whose book club had read it gave a recommendation, which was all that was needed to take the plunge.

I had read at least two excerpts from the book in the New Yorker pre-publication, but only recognized that while reading.  "Being Mortal" was a book that experience here in the past 10 years with parents and in-laws had already put me in touch with.  Some things here worked out well by chance almost, some poorly by what could be charitably called unintended denial, and it certainly would have been helpful to have had this thoughtful point of view before it all happened.  Now the focus is closer to home, or at least it seems that way at the moment.

To go further with personal comments would frankly be too personal for a widely accessible even if not widely known blog.  Gawande touches on important points, looking at the depersonalization of medical care that focuses on cures but not necessarily the ordeal of the patient, and looking at the science of a cure rather than the human needs of the person being treated. Well, to change my mind, I guess a few brief personal comments about just my parents can be mentioned to make this comment come alive.

My mother's end of life time was spent in a pristine and antiseptic nursing home.  She was taken care of well from a medical point of view, but from what could be seen during short visits to Virginia there was no stimulation or companionship intended or available. It was possibly available for ambulatory and almost healthy residents, but not for someone in my mother's condition.  Although frail, she could express her thoughts.  In her last months, when visited her primary message was "I want to go home".  That was not a decision that I could make.  It was heartbreaking and I do not choose to elaborate more about that difficult time. She died alone sometime in the middle of the night a few weeks after my last visit, two days after her 86th birthday.

My father's end of life period was in a hospital for several weeks and during that time I was able to be in Virginia for an extended period.  His home was an assisted living facility at that point, but I don't think he realized at first that he could go to that home.  The hospital and his attending doctor did not seem to realize it or want to allow it as well, but the excellent staff at the assisted living center helped me, and told me that he could come "home" if I arranged for hospice.  The attending doctor would not look at me or speak to me after that, and under her breath, but audibly, she cursed me.  It should be noted that a few other doctors and the head pharmacist quietly supported my effort.

As we left the hospital, my father marveled that all of the tubes and needles had been removed from his arms, rubbing them with wonder. He was overjoyed to get back to Stratford House, and his apartment.  For several days well wishers at the home came by,  and I cooked a prime rib dinner one night(cut into very small bites) and for once didn't set off the fire alarm.  He had his usual watermelon, toast, and coffee for breakfast, propped up in his just added hospital bed.  For three days he was content, and whether happy or just relieved to have some peace it didn't matter.  He slept more and more for a few days after that, with me or one of his wonderful small town caretakers at his side. As I was told might happen, he gave in when I took a break in another room of the apartment --- one big breath.  Pain, hallucinations, and aggravation, and ripping needles out of his arms in fits of anger was a hospital event.  Hospice was none of that.

What has just been described is part of Gawande's message played out.  "Being Mortal" is much more than this, and applying his prescriptions in real situations sounds daunting.  At times in the first part of the book, the message interpreted here seemed to be that everyone as they aged should check on their supply of Tylenol PM and vodka just in case.  As the book progressed it still dealt with situations in a positive if not necessarily easy way.  There is a habit here of making tiny dog ears on the bottom pages of personal books that denote something worth revisiting there.  Two chapters toward the end of the book, "Letting Go" and "Hard Conversations", easily won the dog ear award.

Gawande is a knowledgeable physician who is also a talented writer.  His grace on both accounts is visible here, and obviously why the book has built such a large following. Another major reason is that the book is ultimately not just about dying, but instead about what is required to have a life with meaning, one that causes a person to care about waking up in the morning.


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