“Being Mortal, Medicine and What Matters in the End” by Atul Gawande

Disclaimer: The views and opinions expressed in these articles are those of the authors and do not necessarily reflect the official policy or position of Temple Micah.

Micah Reader in January 2018 by Brenda Levenson

Published in 2016, Atul Gawande’s book tells the stories of patients that he and other physicians treated. They are of all ages, and suffering from incurable conditions. As Atul Gawande brings us into their lives, the reading experience is often emotional. Atul Gawande “is a mensh…. He cares,” remarked one of our readers.

The most wrenching pages are about younger patients; a pregnant woman who is diagnosed with a disease that is not treatable is among the difficult cases to read. But given the average age of our group, shared experiences about parents tended to be the focus of our meeting. Atul Gawande addresses the issue of how to talk to patients as their death approaches by referring to his conversation with Susan Block, a palliative care specialist who is nationally recognized as a “pioneer in training doctors and others in managing end-of-life issues with patients and their families.” Careful use of words, and questions rather than statements were part of her advice. One of our readers raised the need to engage in a discussion with family members early on about our wishes, the sooner the better.

One of our readers raised the need to engage in a discussion with family members early on about our chapter of the book is dedicated to three-step retirement homes in which nursing is the final level.  Much has changed since such facilities were started in the early 1950s with a view on what the elderly might want, a measure of control on their activities, the freedom to make decisions, privacy and respect of their individual needs, said our readers. Current homes are far from the original model, says Gawande. He calls present day nursing homes  “a menagerie of watered-down versions with fewer services.” “The three plagues of nursing home existence” he writes are “boredom, loneliness and helplessness.” As a remedy to all three, a young physician in charge of such a home introduced the presence of animals, dogs, cats, birds, as well as day care centers for the staff’s children, who come and visit. In spite of the initial reluctance of the home’s personnel, the elderly have benefited from his innovation.

Atul Gawande writes movingly about his father who was also a physician. He died of cancer and for one of our readers “the pages about his final days and death were the highlight of the book.” Many of us could undoubtedly concur. There was much to be learned from the observations of our group about their parents, changes in personality for one, sometimes for the best and sometimes not.

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