When I mention BEING MORTAL, the important Atul Gawande’s book, my interlocutors point to their shelf, their desk, their couch. The book is there. They already read it or they plan to read it. My copy came from my brother-in-law. A book rep, he got it for free. He encouraged me to pass it around. Here it is, my “shout out” for a doctor and teacher who recognizes that he was not equipped to talk about “that”. The book chronicles his progress towards empathy and meaningful dialogs with patients.
Gawande starts by describing the absence of decent and coherent long term care offered to our elders, with a few exceptions. The rest of the book focuses on the difficulty to implement coherent and decent decisions as life’s end nears. “I learned a lot of things in medical school but mortality was not one of them.” (p.1) Few doctors are ready for “the conversation.” They learn about science and technology. They are trained to cure, not so much to listen, watch and accompany. The problem is amplified by a chronic lack of geriatricians in the U.S. Medical students are not attracted to this unglamorous and very complex specialty but our aging population is increasing fast.
Jane E. Brody, the NY Times Science Section veteran, dedicated a recent column to that very topic mentioning Gawande’s book as well as THE CONVERSATION by Dr Angelo E. Volandes http://well.blogs.nytimes.com/2015/02/09/know-the-hard-choices-prolonging-life-entails/?_r=0
Throughout palliative care blogs, I have read many case studies similar to the ones described in BEING MORTAL. I knew the shape of the stories, but the book gave me courage and tools. By page 261 (the last) I had become familiar with the list of open questions that Dr Gawande asks by the bedside or in his office, to the patient, the family, and even to his own father. When it is time for major decisions, I now have the words:
• What is your understanding about what is happening to you?
• What are your fears?
• If time becomes short, what is most important to you?
• What gives your life meaning and joy?
• What are you looking forward to?
• What goals are the most important to you now?
• How much are you willing to go through to have a shot at being alive.
• What level of being alive is tolerable to you?