March 5, 2018

Obituary of a Reader + Being Mortal, by Atul Gawande

My mom ran across this obituary in the Logan Herald Journal and called me up to tell me about it.

Beula May Sorenson Worthen
(died at age 90)

I read; I wed; I bred; I fed; I read; I led;
I read, read, read; now I'm dead.

Apparently she wrote this single-sentence summary of her life before she died. What a hoot!

[A full obituary follows, with a few more details about family and such. It also mentions that during one of her later years in life she read 478 books!]

Is this what your obituary will say someday?  I think for mine it would have to say something about flowers in there too. Hmm, except that doesn't rhyme. Better get to work on that!

I suppose while we're talking about such things, we may as well talk about this book:

Being Mortal: Medicine, and What Matters in the End, by Atul Gawande

5 stars: This should be required reading for every family.

I am glad I decided to buy this book! It was every bit as good as I had heard. Gawande--a surgeon-- talks about how our medical system is broken when it comes to end-of-life care. Often quality of remaining life is sacrificed for trying one more thing or doing one more surgery. He goes into the history of nursing homes, and the rise of assisted living centers and senior communities. He also talks quite extensively about hospice care--the one part of the industry that seems to be getting things right.

A palliative care specialist gave him a list of questions to ask to get at the heart of what someone wants the end of their life to be like. These are hard questions to ask, but they bring much-needed clarity, and allow for healthcare decisions to be made by others, should the person in question be unable to do so. Gawande tells the story of the end of his Dad's life, and at one point talks about the hard conversation they had revolving around these questions.

Here they are:

1. What is your understanding of your condition and prognosis?

2. What are your concerns or fears about what lies ahead?

3. What kinds of trade-offs are you willing to make or not willing to make to try and stop what is happening to you?

4. What are your goals for the time you have remaining; how do you want to spend your time if your health worsens?

5. Who do you want to make decisions if you can't?

In the case of Gawande's father, also a doctor, he knew his condition (from a spinal cord tumor) and prognosis were worsening. He was becoming paraplegic. He worried about becoming a burden on his wife. His goals were to finish his Rotary responsibilities and make sure the college he had started back in India and his family were going to be all right. As far as trade-offs went, he most emphatically did not want to be completely paralyzed from the neck down, on a ventilator, requiring constant care for every basic need.

This conversation became very important in the middle of the surgery on his dad's tumor, when the surgeon came out and explained that his dad's heart had gone into an abnormal pattern. Should they stop the surgery or keep going? Gawande, recalling his dad's answers to the Hard Questions, asked one of his own to the surgeon--which option would make it more likely that his dad would end up completely paralyzed--stopping or continuing? "Stopping," was the answer. So Gawande instructed him to keep going with the surgery.

He talks about the importance of hope, but also the importance of looking reality square in the eyes and preparing for it. Most cancer survival outcomes, for example, follow a curve with a big hump in the middle--be it months or a couple of years, depending on the type--and a long skinny tail going off to the right of the chart. Meaning, a handful of people manage to survive years and years, but most do not. Medicine, however, is bent on chasing that tail--at all costs. Unless the patient puts a stop to it.

It's hard, because no-one wants to be the dream-crusher; and we know positive thinking can do amazing things for the immune system. So, many times doctors are not as clear as they could be when discussing potential harm/benefits from various treatment options, leaving the patient to hope falsely, or to put more stock in a treatment than they should.

I want my husband to read this and give me his take on it, as one in the medical profession.

Have you read it? What did you think?

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