A few things have happened recently to friends that remind me that we are mortal and life is transitory. I don't think people in their 40's, 50's think too much about the transitory part but when you get to be my age you think about it. I'm not saying that you spend your days worrying about dying but when you have lost a spouse and dear friends, you wonder about what is going to happen. About how you are going to get from living to being dead. I know that sounds weird. Still, I don't know anyone who wants to suffer or their families to suffer with them through a long illness where there is no chance of recovery.
I recently read Atul Gawande's book, On Being Mortal; Medicine and What Matters in the End. Gawande is a surgeon and has written several books about medicine. He also writes about medical issues in the NewYorker Magazine. Gawande apparently has struggled in his own medical practice on how to handle patients when he knows that medicine can not heal them. He wrote this book after his Father, also a surgeon, died from a rare form of cancer and as Gawande was with his Father through his illness, he saw medicine from the standpoint of the patient and his family.
The book is about the end of our lives and how to manage when our body begins to fail us. He writes about assisted living and nursing homes and why many elderly people are not happy living in these facilities. It is because they lose control of their lives in order that their families feel they are safe and the facility can operate efficiently. Losing control of when you want to get up in the morning, eat, take a bath, watch TV and giving up privacy is hard to accept no matter if you are old and your body is failing.
The last half of the book about medical care in the last part of life brought back memories of so many doctor visits with Ned as we negotiated his last months.
Gawande writes:
“The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don't want a general who fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn't, someone who understood that the damage is greatest if all you do is fight to the bitter end.”Fighting to the bitter end, Ned's last couple of months were overwhelming with visits to specialist who couldn't help, radiation that left him even more exhausted and more tests.
How do we find the right doctors that do not keep offering medical procedures that may prolong life but make it impossible for us to live our last days as we want, a doctor who can help us understand what is happening, ask us what is important and coach us through rational choices.
I think this is a great book for those of us who are in the "third age" as we call it here in Mexico but also it is a good book for our adult children to read as well.
The image of the bottles that once held medicines and potions is from the Port Aransas project.
Excellent points, Billie. Gawande has an insightful article in the New Yorker about how people have been oversold and swindled by the hopes of modern medicine. http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
ReplyDeleteJennifer, I read the article and I couldn't agree more. Certainly business issues and the fear of being sued push the doctor but then the patient does too. If we have a pain, we want to know what it is and we want it fixed. It isn't an easy problem to fix but I'm really happy to read about the changes that have happened in McAllen. Maybe there is hope.
DeleteAbout how you are going to get from living to being dead. " A DNR is the best friend a person can have at the end. It needs to be in place when there is still light at the end of the tunnel but the light is more than likely a freight train barreling down your track.
ReplyDeleteAnd the old bottles,I was rehabbing a 1880s era house in Ashtabula's Harbor area a few years ago . I found a couple of dozen old medicine bottles with a loop of silk ribbon around their necks down the inside of a wall. I found one with a bit of dried liquid in it with a label from 1902. It still had ten feet of ribbon attached to a nail that one could reach from the attic. The former tenant had had a long relationship with addiction would be my guess.
Yes, we need a DNR but that is at the end of life. There are a lot of issues before then like when to call in hospice, whether a surgery should even be done on an 80 year old, etc.
DeleteThe story about the bottles is interesting. There were a lot of medicines you could buy that included narcotics back in the "old days."
As to general anesthesia type surgery, 80 is very risky even for those in the best physical condition in my personal . very limited experience.
DeleteBillie, I really enjoyed the book, too. One of my biggest takeaways was that we need to discuss and think about what the real goal is. Is it something like "to be able to walk to the mailbox and have lunch with friends" or is it " to live without pain" or "to be able to walk my granddaughter down the aisle."
ReplyDeleteTo think about specifics, not just accept medical interventions if they won't help you achieve your articulated goal.
I don't comment often, Billie but I do enjoy your posts and hope to see you again one day!
Nancy, didn't you think it was interesting that even the Gawandes who were both doctors ended up buying to some treatment that they later regretted. I found it hard at times to know what questions I should be asking for Ned. I think it is hard to find the right doctor who can coach you though your decision making.
DeleteLOVE the photo. GREAT post too. I have often known that, for certain friends, the stage of their cancer made it hopeless for a cure. I so wanted to say, "Do what YOU want to do and leave the doctors alone" but, then I hesitate and watch the inevitable happen.
ReplyDeleteBeing widowed at 36 with a 36 year old husband has made me ALWAYS aware of the end..........and my mantra is to live EVERY day as though it is the only one! I don't know what else to do........hopefully when the end comes, I'll be sitting with my feet in the sand drinking a pina colada and watching the waves come in!
Barbara, you are good at living in the moment. Okay, which beach do you want to be sitting on when the time comes? We'll do our best to get you there. LOL
DeleteOne f my favorite books in Salem was Dr. Nuland's How We Die. His philosophy seems to be similar to Dr. Gawande's. The trick, as you say, is to find a doctor with similar feelings.
ReplyDeleteSherwin Nuland's book was an invaluable resource when my sister and I were dealing with my mother's death. She wanted a home death, we had an understand physician who made house calls and nurses in attendance, but we were still surfing the web in search of what to do next, referring to our efforts as the 90s version of boiling water and tearing up sheets. Mexico is the only place to be when you're due for what Steve would call a "major change of address."
DeleteIt has been a while since I read Dr. Nuland's book. I think a lot of doctors feel that way for themselves but find it hard not to offer the hope of cure to their patients. And of course, a lot of patients find it hard to accept that they are going to die.
DeleteBillie - Very thought provoking essay. I tend to avoid pondering that inevitability. At least up to now ;-(
ReplyDeleteI will read the book.
Calypso, just because you will most likely not go back to the US for medical care in your "elder years" you will avoid a lot of the nonsense that goes on there.
DeleteBillie - Indeed you have me pegged right. I will take my chances in Mexico. I am committed to that.
DeleteSome months ago listened on public radio to the broadcasts of the 2014 lecture series Dr. Gawande did for the BBC. Well worth the time.
ReplyDeleteFelix, our gardener and constant source of inspiration in some ways, was telling me about his dad, who is 71 but looks about 81 if not older, and the fact that he's sick but doesn't want to go to the hospital because he thinks he is going to die there and he'd rather die at home. The old bastard I think suffers primarily from terminal contrariness and ignorance but, as I asked Felix, if he doesn't want to go to the hospital you can't very well strap him on the back of a pickup and take him there. I said to Felix that perhaps the only answer is to pay attention to his dad, regardless of the consequences.
ReplyDeleteAlcuban, the old man has a point. More people die in hospitals than most anywhere else except for wars, schools and movie theaters. Besides who knows what else could happen to him. Hospitals are full of sick people and germs and bacteria and viruses and who knows what else.
DeleteOn the other hand, I think you are right about paying attention to his Dad now. He will never regret it.