Being Mortal
What an amazing read by Dr. Atul Gawande (2017)!
This book is about the modern, and I would even say, western experience of mortality. Who we are as humans and how we age and die, has a lot to do with today’s medicine. Institutions have changed the dying experience, with policies that are often opposing our own ideas about how to deal with our finality.
Medicine often fails people – through prevention, injury, sickness, and when dying. The death process is particularly disheartening. The waning days of our lives are sacrificed to treatment algorithms that stupefy our brains and suck our bodies of energy for any last ditch effort of a good “finish”.
Our current system and structure lacks the imagination of how people might want live successfully and fully all the way through until their very end. The institution of dying is an out of control force putting our fates in the hands of corporate medicine, technology, and – really - strangers.
Historically, medicine was just another tool you could try, no different from a healing ritual, a visit to your local apothecary, or a secret family remedy, and sometimes, no more effective. Research and the commercialization of drugs, provided the impetus for medicine to become more powerful, and the modern hospital brought forward a different idea.
The hospital became a place where you could go requesting, and even demanding, a cure. In doing so though, you had to give up autonomy to the direction of doctors and nurses. You had to submit to a new dress code, eating plan, and spread this and that for a look here and there, as a means to finding the “cure”.
No one ever finds their hospital stay pleasant, but you can expect results. Hospitals – and the professionals that work there – have learned how to eliminate infections, remove cancerous tumors, reconstruct shattered bones, fix hernias, repair heart valves, and stop hemorrhaging stomach ulcers. Hospitals have now become the normal place for people to go with their physical troubles, including the troubles of aging.
Medicine and the institutions it has generated for the care of the sick and the old, have a focused approach to “fix” some THING – even if the person/patient has needs other than the “fix”. Medicine’s focus is narrow. Medical professionals concentrate on the repair of health, not the issue of wellness or nourishment of the soul. Yet someone, somewhere decided that they should be the ones who largely define how we live out our end days.
Since the beginning of modernized medicine, we have elected that sickness, aging, and mortality are purely medical concerns. We have been socialized to put our trust, and really our fates, in the hands of people valued more for their academics and their technical skills than for their understanding of human needs.
If we seek a life of worth and purpose – and I’ll venture that most of us do - then we need another way to convalesce and to die, because what we HAVE denies the environment and the conditions to make this possible.
Are we ready to rebel against the way medicine and institutions take control of our lives in sickness, in old age, and during our final days? Do we really expect more from life than just safety? What is the “hard” conversation that we need to have….with ourselves and with others?
Dr. Gawande has eloquently provided these evocative questions to consider whenever a serious issue is at hand, including sickness, injury, or pending mortality:
· What is your understanding of the situation and its potential outcomes?
· What are your fears and what are your hopes?
· What are the trade-offs you are willing to make and not willing to make?
· What is the course of action that best serves this understanding?
Are you ready to live and die on your own terms?