Even though scientists and astronomers say we have been around for pretty long in this world, we have yet to get to terms with our mortality. We tend to coat illnesses, terminal illnesses with some chocolate sauce so we always believe the future will be better. Irrational and unscientific though it may seem, emotion blocks all reasoning and when a near and dear is ill, all the focus is on how to lengthen his or her life. How to save the person from dying? Atul Gawande says that should not be the priority.
Dr Gawande is a surgeon, writer and a public health researcher. His book “Being Mortal” is the current rage. A plain white cover has a single grass on it which he says has a Biblical reference, “All Flesh is Grass.”
So while he tells us the way of all flesh, “People have priorities besides living longer and medicine does not recognize that. The best method to know what their priorities are is to ask, and we do not ask…I can go into the operation room, fix a problem and that’s incredibly gratifying. But when it is an un-fixable problem …you know that their frailty is just getting worse, their chronic illness is not getting better, they are terminally ill and you are not changing their trajectory…that is where you feel really incompetent…if you study such patients (who are terminally ill) less than a third have any such discussions, thoughts and priorities for the end of their life. People who had these discussions had remarkably better outcomes in terms of spending more time at home, having less suffering in the course of their care, family members have less depression and post traumatic disorder six months after the person died. Our core values are to help the person survive. When you start saying people have other priorities besides just survival and well-being for people is bigger than being a pulsing organism that is just kept alive, then you realize that you are going to need to change from a very narrow medical viewpoint to a larger viewpoint. For my parents their Hindu faith was really important to them as he faced what he knew was going to be his death. In medicine people underestimate the role of religion. In the first three priorities that people have, making peace with God at the end of life is really important to them. Much lower on the list is living as long as you can no matter what.”
Writing the book has had a great impact on Gawande’s practice for he realized we do not do such a good job dealing with mortality. Saying goodbye, preserving some quality of life to the end are some of the ideas that need greater attention than just dying hooked on to a few machines. “My grandfather Sitaram Gawande had the kind of old age we all would like to have. He lived to 110 years and was bedridden for the last 10 years, but he remained the centre of the family…people came to him, he made decisions, right to the end. Why do we not have that now? That was what America, Europe had in the nineteenth century and that is what India, Korea are leaving right now. Why? The break-up of the extended family taking care of somebody like him happened only by enslaving the young. Young women to provide the care and then on top of it…his sons, near 80 still waiting to inherit…economic future still depending on your dad. But economic freedom to the young brings progress…so we just turned to medicine and take the elderly to the doctor to ‘fix’ problems.”
Gawande says that this is how we move from specialist to specialist in search of a solution. He says medicine does not teach science of the aging body and dying. What are skills required to help achieve the best possible outcomes? And he relates how he walked into a Geriatrics clinic and found the major fear for people above 80 was that they should not fall. The doctor was helping them address just that.
Accept dying, both as a patient and as a doctor, learn to look beyond, is the take home….till the elixir is found, that is.
sudhamahi@gmail.com
Web link:
https://www.youtube.com/watch?v=LcPqcrZPFBc
https://www.youtube.com/watch?v=KA32crcXOI0
