Being Mortal…...

I've just finished reading a very good, thoughtful book. Being Mortal: Medicine and What Matters In the End by Atul Gawande. Written by a physician it really brings into focus how our society and our medical community treats people, no matter what age, as they approach the end of life. Most of the book focused on health care for the elderly, and how it fails…..but not every example involved someone who had enjoyed a good long life. Some were sadder stories of lives cut short, young families left behind.

Every chapter, no I take that back….every page gave me pause and something to think about. Of course working for hospice also provided me with many opportunities to examine what I thought about what I wanted at the end of my journey….but thinking about it in the abstract and actually facing the dying process are certainly two very different things. My thoughts about my wishes are still a work in progress.

Many of Dr. Gawande's quotes made me stop and think. "People with serous illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete."

"The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don't, mortality is just a horror. But if you do, it is not." Later he goes on to state: "We become less interested in the rewards of achieving and accumulating, and more interested in the rewards of simply being. Yet while we may feel less ambitious, we also become concerned for our legacy. And we have a deep need to identify purposes outside ourselves that make living feel meaningful and worthwhile."

I remember training our hospice volunteers and reminding them that each of our patients wanted and needed to know that they mattered that they'd made a difference in the world. Maybe in a very "small" way by raising a family (after all…..most of us do operate on a pretty small stage)…but they mattered to those that loved them, to their neighbors, to their communities. They made a difference while they were in the world.

A sad conclusion of the book is that most physicians are simply not asking their patients the right questions. Instead of offering yet another round of medication/treatment/surgery doctors should be asking "What matters most to you?" Patients usually don't realize they may have choices and those choices would make their last months/weeks/days more comfortable and allow them to live life to the fullest as they say goodbye.

"Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits…..But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be……We've been wrong about what our job is in medicine. 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 be alive."

So much to consider…..such important converations to have with those we love. I'm healthy and expect to enjoy many more years….but hospice also taught me you never know what's just around the corner. So what are my wishes…..what will my legacy be?

Food for thought. Look for the book. Please read it and maybe buy a copy for your doctor?