I found out about this book after reading a review of it by fellow blogger, Hilary Custance Green. Her enthusiastic post prompted me to reserve a copy from my local library.
Atul Gawande is a surgeon, living and working in the USA, who has written several best-selling books about medical science. In ‘Being mortal’ he deals with the issues surrounding terminally ill people, particularly the elderly, when they become increasingly dependent on outside care and assistance.
The book describes how care homes and hospices grew out of medical establishments, and how this has led to them focussing strongly on medical intervention. Their evolution has shaped the way in which the ageing population is treated, especially in westernised nations, although increasingly also in the developing world.
Gawande cites examples of terminally ill patients, some of whom were under his care, commenting on how communication techniques helped, or hindered, them in making decisions about treatments. He admits he has, at times, failed to state clearly to a patient what they should expect, or has softened the reality of their situation. As a doctor, he wants to find ways of fixing the various problems presented to him. When someone is terminally ill, however, there comes a time when it’s arguably more humane not to treat them than to subject them to yet more treatments. It often comes down to a trade-off between prolonging life for a short time and introducing unwanted side effects that diminish quality of life.
One of the most moving aspects of the book is the story of Atul Gawande’s father, who was himself a doctor and underwent various difficult treatments during a terminal illness. It was only by facing up to tough conversations that Gawande learned how his father wanted to be cared for in the latter stages of his illness. For him, avoiding suffering and being with his family were of critical importance. He spent his last days in his own house with enough painkillers to allow him to enjoy the company of his family without pain.
Gawande suggests there can’t be many people who would want to die in hospital and yet, because of the way our society operates, a large number of people do just that each year. Giving someone more options, allowing them to choose where they spend their last days, is not only preferable for the terminally ill patient, but gives comfort and reassurance to those left behind. With a little bit of forethought and the courage to face what is, after all, coming to each of us, we can perhaps make dying a less lonely and frightening prospect.