I read this at the suggestion of my sister Danna. Presumably she was thinking of our parents, who are in their 70s. We also like a lot of the same books. When you see me reading a book by a dude, it's typically either on a syllabus for my grad degree or because Danna told me to read it. This intro is just to say that I wouldn't have picked up Being Mortal on my own. I'm glad I did. It is a profound look at end of life care and what most practioners, outside of most gerontologists and hospice caregivers are doing wrong.
The geriatric team wasn't doing lung biopsies or back surgery or insertion of automatic defrailers. What they did was to simplify medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient's home was safe.
Gawande's argument is that people with terminal illnesses care more about quality of life than length of life, or even safety. People who love sick a sick person should not swap their loved one's walker for a wheelchair or limit their consumption of their favorite foods quite so quickly. What the gerontologists and hospice professionals, and eventually Dr. Gawande after he gets woke to the needs of the dying, do to care for their patients is help them set goals. Medical and surgical care comes from what the patient prioritizes. Having discussions about end-of-life needs is hard, but Gawande shares findings that the discussions help people have a better death. It also helps the survivors. Six months after their loved one's death they show less depression than people who did not have clarity about what the deceased wanted. Making end-of-life care decisions is hard, so they best thing to do is not to decide. Have the discussion beforehand, and it's a done deal and a way to serve the dying person. No "this is what they would have wanted." Just "this is what they want."
I bookmarked 14 passages. I'll spare you, because I think I got the gist of it, above.
But some things to think about:
The eight "Activities of Daily Living"
- use the toilet
- get out of bed
- get out of a chair
The eight "Independent Activities of Daily Living"
- shop for yourself
- prepare your own food
- maintain your housekeeping
- do your laundry
- manage your medications
- make phone calls
- travel on your own
- handle your finances
I was taken by Gawande's take why the historic reverence of elders is changing.
As for the exclusive hold that elders once had on knowledge and wisdom, that, too, has eroded, thanks to technologies of communication--starting with writing itself and extending to the Internet and beyond. New technology also creates new occupations and requires new expertise, which further undermines the value of long experience and seasoned judgment. At one time, we might have turned to an old-timer to explain the world. Now we consult Google, and if we have any trouble with the computer, we ask a teenager.
He challenges the concept that adult children caring for their parents is ideal. The parents don't want it anymore than the "kids" do. As long as they have the money and ability to live automously, they prefer it. Taking care of animals, or even plants helps sick people a lot, too. They can focus on the animal's needs and be less worried about their fears and pains.
I'm terrified of aging, but not of dying. I may be right in that fear, because Gawande notes that people with at least one daugher receive the best care in their old age. I call Bad Bad Leroy Brown my little girl, but I don't expect my beloved tabby to be much of a death doula for me. Maybe it's all the more important for childless folks such as myself and my spouse to lay down our wants and needs.
Despite the rising percentage of old people in the world's population, geronotology is a waning field that is unsexy to funders. Alas.
Gawande is a solid writer and keeps things personal enough for fiction/memoir preferrers like me. And he's not Dr. Knowseverything, which I appreciate.