On
ageing and dying…
[Review
on Atul Gawande’s “Being Mortal”, Penguin in the Literary Review of the The
Hindu * Sunday, January 04, 2015 by Krithvi Shyam]
Over the years,
along with our enhanced understanding of the human body, medicine has played a
significant role in shaping our experience of life and death. Diseases that may
have killed off our relatives a century ago are now easily side-stepped by
popping a couple of pills or avoiding specific foods. Today we approach life with
a few simple rules – we get vaccinated, we wash our hands, we eat right, we
exercise – with the expectation that these precautionary measures will prolong
our time in this world.
As we grow older,
illness becomes inevitable. But even then we turn to medicine to set us right.
The priority is keeping death at bay for as long as possible. However, the
quest to prolong life becomes so paramount that something equally – if not more
– crucial gets overlooked: the quality of life.
“Our ultimate
goal… is not a good death but a good life,” observes Atul Gawande, surgeon and
staff writer for the New Yorker. His latest book, Being Mortal, is an intimate
exploration of ageing, dying, and the importance of identifying what matters
most in our lives, especially at the very end. While the book focuses on the
US, its lessons are easily applicable across the world.
Two themes play a
recurring role; one is our need for autonomy. With case studies that are likely
to leave you bleary-eyed, Gawande narrates personal accounts individuals coming
to grips with their sudden and unexpected transition from living independently
to having to rely on others. After all, a reliance on others – children or
professionals – doesn’t just mean seeking help with everyday activities that
you could have earlier performed unconsciously. It also means having to face
restrictions imposed on your freedom in the name of safety; restrictions you
were unprepared for and which wreak havoc with your sense of control over your
life.
The need for
purpose – and grappling with the frustration that comes with not having one –
is the other theme that Gawande touches upon. He cites a successful programme
established at a nursing home for the disabled elderly, where plants and
animals (ranging from parakeets to cats and dogs), were introduced into the
institution. This presented the residents with an opportunity to look after
others instead of feeling helpless themselves.
“We have been
wrong about our job is in medicine,” Guwande notes. “We think our job is to
ensure health and survival. But really it is larger than that. It is to enable
well-being. And well-being is about the reasons one wishes to live.” Part of
enabling well-being is also about being able to help patients make difficult
decisions. To do so would mean trying to understand what their hopes and fears
are, what they want out of life and what they are willing to compromise on, and
what preferences they have when they reach the end.
Having these
discussions can give patients more clarity in a situation where the answer is
seldom clear. If you have a terminal illness, do you opt to try every possible
treatment at the expense of your quality of life, or do you prioritize quality
first, and spend the time you have left on your own terms? Guwande emphasizes the
important role that specialists in palliative care can play in the lives of the
elderly and terminally ill. He cites a 2010 study where patients with stage IV
lung cancer were either provided with the standard oncology care, or oncology
care coupled with meeting with a palliative care specialist. The researchers
found that those in the latter group ended their chemotherapy and entered
hospice (‘comfort care’) earlier, and lived 25 per cent longer than the ones in
the former. Perhaps, “you live longer only when you stop trying to live
longer.”…
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