Friday, August 26, 2016

Being Mortal by Atul Gawande

Eight nattering nabobs of negativism reluctantly checked into the Park Avenue Therapeutic Institution and were welcomed by Dr. Charles Palmer, COO and Gift Shop Coordinator.  The decision to transition from a single family residence to an assisted living facility can be overwhelming to many mature males.  However, the social interactions through snacking experiences and discussion groups soon put them at their ease.  The following comments were overheard in the hall:

Bob S:  I enjoyed the book.  I thought it was well written and informative.  The only chapter that did not resonate with me was the philosophical one, where I had difficulty following.  A-

Mike B:  This is an important book.  I felt Gawande did an excellent job combining data from various studies with personal anecdotes to include his own family.  A-

Tom Eaton:  Originally I thought the book was very depressing - probably because I am closer to this age, with heart problems.  The first part was depressing, but brought you through the evolving convalescent facility history.  I enjoyed the part with the dogs, cats, birds in the facility.  I'm going to send a copy of the book to all my kids, and declare it as mandatory reading.  A

Dick Arms:  When I saw this book in the schedule, I was in denial.  I was trying to think of ways to miss this meeting.  The first half was depressing, and the second half was depressing.  From the standpoint of writing, it was skillful, clear; I think the book was extremely well written, and I'm glad I read it.  I am going to have my daughter and my girlfriend read it.  Solid A.

Keith:  I saw this book as an indictment of the medical community, sans solution.  I went to a medical appointment recently, and was told they had no gerontologist on staff.  The medical community needs more than a wake-up call, they need an epiphany.  They only want to treat my pain and my illness, not address my quality of life.  The AMA has demonstrated not one iota of change.  B-

Dick J:  My wife read this book a couple of years ago, and said I should read it.  I avoided doing so, and Charlie now gets my thanks for choosing this book.  It made me think about these decisions.  A-

Bob W:  I couldn't read this book.  Both my parents died of cancer.  After the discussion, perhaps I should try to read it.

Charlie:  I give it an A.  Gawande is a wizard.  I think he set out to define the problem, and he did.  Given the current climate, and the imposed fee schedule based on CPT codes, the industry is not focused on caring for old people.  Gawande's our designated physician writer and observer.

And from far outside of Brigham and Women's Hospital:

If all goes according to plan, I should be tucked into bed at the Hotel Post in the village of Jungingen in the Swabian Alps at the time your meeting begins. I am truly sorry to miss the discussion. It is an important one to have. My comments about the book follow: 

I found Atul Gawande's Being Mortal the most informative and compassionate discussion of end-of-life situations/questions I have ever read. His observations and conclusions are based on 20 years of research, medical practice, and personal experience with friends and family. The case studies and conversations he built the book around are touching and insightful. What matters in the end, he contends, depends on our own definition of what makes life worth living and what brings us joy. To pursue that according to Gawande, each of us should be allowed to continue to be the author of our own life's story. The book also served as a reminder of how important it is, particularly at this stage of our lives, to focus on everyday pleasures and the people closest to us. I have recommended his book to everyone and will continue to do so. A 
Regards, Jack

I really liked the book, particularly after it got past the early depressing case studies and into chapter 5, A Better Life. I'm going to make that chapter required reading for our kids. That chapter could be "end-of-life-changing" for Susie and me. 

One way the author characterizes the goal of our life that is to come is to: "escape a warehoused oblivion that few really want." (p. 188) I think of my mother transiting into 'warehoused oblivion' as Alzheimer's took her and I've seen many examples of warehoused oblivion when our church's jug band visits various "homes." On the other hand, I've seen heartwarming examples of how music can bring meaning and pleasure to a home's residents. People who can't tell you their name will smile and sing along on songs that are stored somewhere in their brains. My Mom, up to the end, would often break into singing one particular hymn. There are books written on this. 

Then on p. 229, a phrase that captured the theme of chapter 5 is that the goal of aging parents and their families should be for the parents to "live for the best possible day." This simple goal can help make decisions along the way. 

Perhaps this will come out in your discussion, but I wonder how Gawande's criticism of surgeons and other MDs has been responded to by others in the medical field. Unless he was using made up names for patients, MDs that were criticized in the book could be known by name by insiders. That could make things tense at AMA conventions.

Thanks for picking this book. If I make good notes, and mark the pages, I'll be able to indicate to my kids how they should deal with my mortality.

 I did a little online searching to see if I could find Albuquerque facilities that follow the Chapter 5 approaches, e.g., the Green House, but couldn't find any. Does anybody know if any such programs exist here? Grade: A. The author writes well and entertainingly and addresses vital issues. I look forward to reading the reviews.