Over the years, along with our enhanced understanding of the human body, medicine has played a significant role in shaping our experience of life and death. Diseases that may have killed off our relatives a century ago are now easily side-stepped by popping a couple of pills or avoiding specific foods. Today we approach life with a few simple rules — we get vaccinated, we wash our hands, we eat right, we exercise — with the expectation that these precautionary measures will prolong our time in this world.
As we grow older, illness becomes inevitable. But even then we turn to medicine to set us right. The priority is keeping death at bay for as long as possible. However, the quest to prolong life becomes so paramount that something equally — if not more — crucial gets overlooked: the quality of life.
“Our ultimate goal…is not a good death but a good life,” observes Atul Gawande, surgeon and staff writer for the New Yorker . His latest book, Being Mortal , is an intimate exploration of ageing, dying, and the importance of identifying what matters most in our lives, especially at the very end. While the book focuses on the U.S., its lessons are easily applicable across the world.
Two themes play a recurring role; one is our need for autonomy. With case studies that are likely to leave you bleary-eyed, Gawande narrates personal accounts of individuals coming to grips with their sudden and unexpected transition from living independently to having to rely on others. After all, a reliance on others — children or professionals — doesn’t just mean seeking help with everyday activities that you could have earlier performed unconsciously. It also means having to face restrictions imposed on your freedom in the name of safety; restrictions you were unprepared for and which wreak havoc with your sense of control over your life.
The need for purpose — and grappling with the frustration that comes with not having one — is the other theme that Gawande touches upon. He cites a successful programme established at a nursing home for the disabled elderly, where plants and animals (ranging from parakeets to cats and dogs), were introduced into the institution. This presented the residents with an opportunity to look after others instead of feeling helpless themselves.
“We’ve been wrong about what our job is in medicine,” Gawande notes. “We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to live.” Part of enabling well-being is also about being able to help patients make difficult decisions. To do so would mean trying to understand what their hopes and fears are, what they want out of life and what they are willing to compromise on, and what preferences they have when they reach the end.
Having these discussions can give patients more clarity in a situation where the answer is seldom clear. If you have a terminal illness, do you opt to try every possible treatment at the expense of your quality of life, or do you prioritise quality first, and spend the time you have left on your own terms? Gawande emphasises the important role that specialists in palliative care can play in the lives of the elderly and terminally ill. He cites a 2010 study where patients with stage IV lung cancer were either provided with the standard oncology care, or oncology care coupled with meetings with a palliative care specialist. The researchers found that those in the latter group ended their chemotherapy and entered hospice (‘comfort care’) earlier, and lived 25 per cent longer than the ones in the former. Perhaps, “you live longer only when you stop trying to live longer.”
Being Mortal is a difficult book to read, because it forces you to think of answers to life’s unpleasant questions; all the more reason why you should read it. It is written in a conversational style that is meant to educate rather than intimidate, and the insightful observations he makes will have you reaching for a highlighter, in the knowledge that you will be returning to this book for guidance in the future.
Being Mortal; Atul Gawande, Penguin, Rs. 599.
