Being Mortal - An Important Book to Read

I am writing a very different article today because I want to share a wonderful and very important book I read recently that I think is a must read if you or anyone you love plans to grow old or get sick. Maybe you would rather not plan for it, but the fact is either one will happen to all of us some day.

Being Mortal by Atul Gawande.

I am not an expert in book reviews and my intention is not to analyze his book in depth. I have no vested interest in Dr. Gawande’s book, and I share only my opinions today. I want to introduce you to his book because it opens up the opportunity for important conversations with your family as well as thinking about your own mortality.

It is not only a wonderfully written book filled with beautiful as well as heart wrenching stories of patients and family that Dr. Gawande has encountered dealing with end of life issues, but it is highly informative in addressing these issues for each one of us.

For the number of different cultures in the world, there are probably the same number of ways that we approach the later years of life including dying and death. For many of us, it may be something we prefer not to discuss at all. It seems unnecessary when you are young or healthy, and it may feel all too real and painful when you or loved ones are elderly or facing a serious illness.

Health Care Today

The beauty and challenge of health care today is that much can be done to prolong life. This is tremendous when cancer can be treated or the development of heart disease can be slowed. I am grateful for these options and have experienced the benefits with my own family and friends.

I also consider, however, the choices we make when we are unsure of the benefits vs. the risks. I have had family and friends who experienced treatments for disease that at best prolonged their life for a short time; but those last days, weeks and months were painful for both the individual and the family.

Questions to ask

How do we make decisions about how we want our last years of life to be? There are two types of situations that Dr. Gawande confronts in his book: individuals healthy but growing older and those with chronic illness.

• If you are relatively healthy but aren’t able to live in your own home anymore, what would you want your living situation to be?

• In reality, would living with family work for the parent or the child? What are the logistics for taking care of an elderly parent? Is your home and lifestyle set up to allow for that?

• What are the priorities for you that make life worth living?

In Being Mortal we are introduced to one individual whose simple desire is to be able to eat ice cream and watch football. Another, who wants to live in a place where he can still make his own choices about how he chooses to live. These may seem like simple things, but often are not considered if the questions aren’t asked.

If you are facing a serious disease condition, there are different decisions to be made. And those decisions will vary tremendously, depending on age, place in life, or spiritual beliefs.

• At what point is the treatment worth the risk?

• How many weeks/months/years will it prolong my life?

• What will be the challenges throughout the treatment? How will this affect the patient and the family?

Again, Being Mortal introduces us to families of both young and old who have had to make difficult decisions on when to forgo treatment to enjoy the last days, weeks or months of life to the best of their ability.

There are many questions to be asked and answered, some of which can be prepared for long before it becomes necessary. An advanced directive or living will may facilitate that process.

The Importance of an Advanced Directive

An advanced directive allows you to put in writing what your wishes are for end of life care. This document will only be put into effect if you are unable (determined by two physicians) to make medical decisions for yourself. This is a good place to start – requiring you to think about it before you NEED to think about it. To create an advanced directive (living will), you can click on http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289 to get the form for your state.

Why is it important to create an advanced directive? Your decisions about end of life care are important. But, also how it affects your family is important too. Will the decisions you make, or is not having made any decisions prior to the need for them going to make it easier or more painful for your family?

Answers?

Dr. Gawande doesn’t give us answers to these very hard questions. What he gives us are more questions. Wouldn’t it be nice if there were a manual to follow when dealing with end of life issues? Sorry, it doesn’t exist. Every situation, every individual, every family is different. And with each human being the results may vary. A doctor may have statistics to explain the likelihood of success of treatment, but there are never guarantees. We can try to make predictions of how long it is best to live in our own home vs. the benefits of moving to a facility with greater support as well as social connection, but no one will know for sure.

We certainly cannot predict the future, but I do hope that talking about these issues, planning ahead and being prepared for both you and your family can be worth the effort.

Get Dr. Gawande’s book. It will definitely make you think and I hope it makes you act in ways that feel right for you and your family.