Being Mortal:
Medicine and What Matters in the End

HERE’S A MUST READ FOR ANYONE WHO CARES FOR SENIORS!

By: Regina McNamara

I have been a fan of Atul Gawande, a Boston surgeon and award-winning author for years. His wisdom and breadth of caring for his patients is noteworthy. His most recent work, Being Mortal was a Christmas gift from Marissa, my daughter in law, a physician and a new mom.

After several hours of being unable to put down this compelling book, I need to share my thoughts. Dr. Gawande explores the agonizing choices or lack thereof when patients and their loved ones are dealing with late in life medical issues. Our healthcare system, organized and motivated to “Do everything possible” more often than not unwittingly causes more pain, more complications and most seriously, often prevents patients from experiencing the end of life in a well planned, pain free manner in their choice of environment.

His genius for story telling and his generous sharing of his personal experiences with his father’s medical treatment and death reinforce his skills as a physician but more importantly, his genuine humanity. He is a good man as well as an accomplished physician.

He includes insightful exploration into the world of assisted living and nursing homes and has many common sense and well proven strategies for significantly improving the quality of life for residents in facilities. His simple measures also have a positive impact on their care outcomes and the financial success of these facilities.

But it is his work with seriously ill people and helping them to navigate the course of their illness, decide on interventions and find their way to the best possible end to their lives where his true and simple wisdom has its most profound lessons for all of us

His strategy?

Find the courage to ask the following questions of seriously ill patients and loved ones:

•What are your biggest fears and concerns?
•What goals are most important to you?
•What trade offs are you wiling to make, and what ones are you not willing?

Ask each question. Then be quiet and listen. Give them plenty of time to answer. Be non judgmental. Be caring. You may be surprised.

His work in his own practice as well as the research supports the effectiveness of this approach. Palliative care team members most frequently use it. But this method can be used by all family members; all lay people, and all heath care professionals.

The author is, not surprisingly, a major fan of hospice care. As are we.

Too often patients are not truly informed about a hospice/palliative care option. The research shows that when patients are given the appropriate facts, they often choose this route. As a result, they suffer less, were physically more capable, and were able to interact with others for a longer period. Their family members were much less likely to experience regrets or depression.

“People who had substantive discussions with their doctors about end of life preferences were far more likely to die at peace and in control of their situation and spare their families anguish.” Atul Gawande in Being Mortal.

Dr. Gawande’s profound grasp of the reality of the health care system and how we short change patients and families toward the end of life (some would argue life’s most important time) is profound. We can all recognize the sad role we play in this. But we can do better. We can do more. We can ask, then sit back and truly listen. Dr. Gawande has shown us the way. It is simple but it is not easy. It is doable. Most importantly, it is essential. ■