Monday, December 29, 2014
Being Mortal - Atul Gawande
Subtitle: Medicine and What Matters in the End
I'm known in one of my reading groups as the one who reads "Death and Dying" titles. I've pursued the subject since the late 1980's when I lost my Nana, my Dad's mother, to vascular dementia. It launched me on a study of gerontology, then an MBA in Health care Administration and volunteer and paid work with aging organizations, so aging and the end of life are subjects dear to my heart.
I've enjoyed Dr Gawande's previous books and this one is rewarding. It provides many thought provoking discussions on how we interact those with illness and those approaching death and with how we ourselves deal with the end of life.
You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence.
The veneration of elders may be gone, but not because it has been replaced by veneration of youth. It's been replaced by veneration of the independent self.
[On falling] Each year, about 350,000 Americans fall and break a hip. Of those, 40 % end up in a nursing home and 20% are never able to walk again. The three primary risk factors for falling are poor balance, taking more than four prescription medications and muscle weakness.
[On nursing home treatment] In almost none [of the care facilities] does anyone sit down with you and try to figure out what living a life really means to you under the circumstances, let alone help you make a home where that life becomes possible.
Studies find that as people grow older they interact with fewer people and concentrate more on spending time with family and established friends. They focus on being rather than doing and on present more than the future.
[on caring for elderly] ...provide care without calculation or deception, don't impose any goals beyond what the person desires.
Making lives meaningful in old age is new. It therefore requires more imagination and invention than making them merely safe does.
[Questions to ask a person facing illness or death] What are your biggest fears and concerns? What goals are most important to you? What trade offs are you willing to make and what ones are you not?
...our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one's story is essential to sustaining meaning in life.
The job in medicine...is to enable well-being. And well-being is about the reasons one wishes to be alive.
Published: 2014 Read: December 2014 Genre: Non-fiction, aging, medicine
ISBN: 978 1 62779 055 0