Monday, October 06, 2014

If only doctors would let us mortals have happy endings!

There are a gazillion bozos like me who idle away our time.  And then there are the likes of Atul Gawande.

I am not a Gawande fan because he is an Indian-American.  That helps, of course.

I love his essays in the New Yorker.  Now, I am not a fan just because of his essays in the magazine that I love love.

I am simply amazed at how he does it all!  Oh well, I suppose somebody has to do the heavy-lifting so that the lazybones like me can coast through life, right?

But, come on, really, how can he do all the things he has listed in his webpage?  Maybe like in that glorious scene from Duck Soup, there is more than one Gawande around and they are all fooling us ;)

Gawande has come out with yet another book.  Being Mortal: Medicine and What Matters in the End.  Give him a book award already, people.

Does it then mean that Gawande has already started working on his new book, while I watch reruns of Everybody Loves Raymond?  I hate this Gawande guy for making me seem like a sloth, in comparison!

How did Gawande do the work for this book on the end of life and how medical care deals with it?
for three years, I researched a book on what has gone wrong with the way we manage mortality and how we could do better.
I spoke with more than 200 people about their experiences with aging or serious illness, or dealing with a family member’s — many of them my own patients, some in my own family. I interviewed and shadowed front-line staff members in old age homes, palliative- care specialists, hospice workers, geriatricians, nursing home reformers, pioneers, and contrarians.
How does he do that and everything else?  Have you checked his Wiki biography?  Anyway, back to the book on the end of life care:
People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world. These moments are among life’s most important, for both the dying and those left behind. And the way we in medicine deny people these moments, out of obtuseness and neglect, should be cause for our unending shame.
The Economist reviews the book:
In this eloquent, moving book Atul Gawande, a general surgeon and author of other thoughtful works on the doctor’s trade, explains how and why modern medicine has turned the end of life into something so horrible. “Over and over, we in medicine inflict deep gouges at the end of people’s lives and then stand oblivious to the harm done,” he says. The book’s focus is America, which spends vast sums on dubious end-of-life treatments.
Yes, I am back to blogging about death, dying, and our bizarre fascination to spend obscene amount of money in order to extend life on this planet by an additional day or two.  You thought, hoped, that I would have forgotten about these topics, eh!  Not so fast, dear reader, not so fast.
Rightly, doctors have abandoned the paternalism that used to lead them to conceal terminal prognoses. But they have failed to find a voice and the courage to guide their patients through the various treatments between which they are supposed to choose, too often hiding behind “informed consent”. That too few geriatric specialists are being trained has not helped; in America only 300 graduate every year. Meanwhile, for those people who live long enough to become frail before dying, a nursing home that puts safety before anything that might make their final days worth living awaits. “Our most cruel failure in how we treat the sick and the aged”, says Dr Gawande, “is the failure to recognise that they have priorities beyond merely being safe and living longer.”
Many passages in “Being Mortal” will bring a lump to the throat, but Dr Gawande also visits places offering a better way to manage life’s end: a Jewish retirement community on the same site as a school where the residents can act as tutors; a nursing home filled with pets for patients to care for; a sheltered-housing programme that commits itself to supporting all residents, no matter how complex their needs. And Dr Gawande himself learns to have better conversations with the sick and dying.
Can you cut to the chase, please, because we live in a world in which people do not have even thirty minutes for serious, undisturbed, reading.
“If end-of-life discussions were an experimental drug, the FDA [an American regulatory body] would approve it,” says Dr Gawande. In life, as in all stories, he writes, “endings matter”.
There, that's succinct. Gawande rocks! Endings matter, indeed.

Turns out that the guy is on Twitter too, and has tweeted about the Economist's favorable review of his book.

Seriously, how does he do it all?

BTW, have you given enough thought to your own end of life?  If you have not, maybe Gawande's book is what you need.
If you have already figured out the advance directives, then maybe Gawande's book is what you need for you to feel reassured you did the right thing.
You can never go wrong with Atul Gawande's writings.

4 comments:

Ramesh said...

A moving post and one that is prompting me to buy his book asap. The book is being released in India only in end October, so I will wait.

The theme resonates absolutely. Yes, Yes and Yes to everything you have posted.

Wait - how can I agree wholeheartedly with you for two consecutive posts. No way. OK - Atul Gawande must be a nut to tweet - there you are . I have disagreed with something :)

Sriram Khé said...

I am sure you will like Gawande's style.

This, on top of the Roz Chast book, might even make you sign up like I have for a contract with the cosmos to exit the stage at 75 ... so, better catch up on all your sports programs on TV ;)

Ramesh said...

Saw him even on Jon Stewart yesterday
http://www.youtube.com/watch?v=Lb61PXoCniw

Sriram Khé said...

On Oregon's "Death with Dignity" and a 29-year old young woman moving to Oregon from California after her doctors gave her the bad news of advanced stage brain cancer:

www.youtube.com/watch?v=yPfe3rCcUeQ