The Substance of Faith

The Substance of Faith

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Book Review — Being Mortal

 

Being MOrtal

With the advent of the DVD, movie makers have offered viewers the option to watch alternate endings to their favorite movies.  “Director’s cuts’ lets us choose one ending over another, according to our preferences.

Atul Gawande’s book, Being Mortal,  allows individuals in declining health or with a terminal illness to consider alternate endings to their own lives.  For the aging, a typical ending includes a declines in mobility, mental function, and control over the most basic elements of life.  The most common questions along this path include, when shall we move mom to a nursing home?  Which one shall we use?”  Neither the surrounding family nor the new nursing home resident finds the path hopeful or healing.   Inevitably, the quality of life declines.

Gawande, a surgeon by training, explains why the traditional path rarely leads to a satisfying quality of life and then outlines simple steps that have proven to enhance life for aging people who need extended care.  He describes more attractive alternate endings.

After discussing possible solutions for elder care, Guwande turns to similar factors surrounding the care of the terminally ill. As a physician he admits that he and other doctors have a very difficult time admitting when a patient has reached a stage when science and medicine cannot cure them.  Not knowing any other way to treat the problem, physicians often keep pouring more and more medical treatment on a fire that will not be put out.   Chemo to the last minute, or debilitating surgeries with little hope of changing the outcome are not always the answer.

You can watch the PBS Frontline episode on Being Mortal here.

Gawande suggests that medical professionals learn to recognize watershed moments and learn to have conversations with their patients.  He offers three questions to guide these discussions:

  • How do you understand your condition?
  • When we know the time is short, what are your goals?
  • What trade offs are you willing to make to reach those goals?

The first question provides a context for the patient and physician to be honest about the prognosis.  The second question helps the treatment team know what is important to the patient.  Does the grandparent want  to take grandchildren to Disney World one last time? Does the music teacher want to continue giving lessons as long as possible.  Does the sports fan want to watch one more season of football?  Knowing these goals allows  care givers to suggest the best ways to accomplish them.  And, finally, when the situation is terminal, there are always trade offs. Does the patient choose pain over lucidity or lucidity over pain?  What other trade offs are acceptable?  Each case is unique, so it is important to know.

Above all, Guwande encourages conversations that include care givers, patients, and family.  These honest discussions are critical to discovering the best endings – the ones with the highest quality of life and the deepest satisfaction for the patient.  We must get over our denial of death if we want to encourage the fullest life to the very end of mortality.

The fact that Guwande illustrates many of his points with examples from his own father’s decline and death gives him great credibility.

I’ve sought out people in the health care profession who have read this book, and I’ve encouraged others to read it, even giving away a few copies to people I think could carry this discussion forward on a local level.

Hospice workers are very pleased these conversations are going mainstream. Other ministers have commented on how helpful it is to have the rubric of Gawande’s questions in discussing these matters with church members who feel the pressure to make decisions in critical moments.

Ministers and caregivers who regularly encounter aging patients or those in terminal circumstances will find this book helpful and encouraging.   I believe it will be a watershed book that encourages healthy conversations about the quality of life.

Here are a few quotes from the book:

  • We put off the adaptations that we need to make as a society.  And we blind ourselves to the opportunities that exist to change the individual experience of aging for the better.  p. 35

 

  • They (nursing homes) were never created to help people facing dependency in old age.  They were created to clear out hospital beds- which is why they were called “nursing homes.” p. 71

 

  • This is the consequence of a society that faces the final pause of the human life cycle by trying not to think about it. p. 76f

 

  • At least two kinds of courage are required in aging and sickness, the first is the courage to confront the reality of mortality -the courage to seek out what is to be feared and what is to be hoped….But even more daunting is the courage to act on the truth we find.  p. 232

 

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