[ed. See also: The Best Possible Day.]
Atul Gawande’s “Being Mortal: Medicine and What Matters in the End” introduces its author as a myopically confident medical school student whose seminar in doctor-patient interaction spent an hour on Tolstoy’s novella “The Death of Ivan Ilyich.” As a young man, he was not ready to understand the title character’s loneliness, suffering and desire to be pitied. He saw medical compassion as a given and Ivan Ilyich’s condition as something modern medicine could probably cure. He and his fellow students cared about acquiring knowledge and competence. They did not see mortality as part of the medical equation.
Now a surgeon (and rightfully popular author) in his 40s, Dr. Gawande sees why that story was part of his training. “I never expected that among the most meaningful experiences I’d have as a doctor — and, really, as a human being — would come from helping others deal with what medicine cannot do as well as what it can,” he writes.
Atul Gawande’s “Being Mortal: Medicine and What Matters in the End” introduces its author as a myopically confident medical school student whose seminar in doctor-patient interaction spent an hour on Tolstoy’s novella “The Death of Ivan Ilyich.” As a young man, he was not ready to understand the title character’s loneliness, suffering and desire to be pitied. He saw medical compassion as a given and Ivan Ilyich’s condition as something modern medicine could probably cure. He and his fellow students cared about acquiring knowledge and competence. They did not see mortality as part of the medical equation.
Now a surgeon (and rightfully popular author) in his 40s, Dr. Gawande sees why that story was part of his training. “I never expected that among the most meaningful experiences I’d have as a doctor — and, really, as a human being — would come from helping others deal with what medicine cannot do as well as what it can,” he writes.
“Being Mortal” uses a clear, illuminating style to describe the medical facts and cases that have brought him to that understanding. He begins with an anecdote that illustrates how wrong doctors can be if they let their hubris and fear of straight talk meld with a patient’s blind determination to fight on, no matter what. “Don’t you give up on me,” demands a man with cancer, though the surgery he wants cannot possibly cure him. “He was pursuing little more than a fantasy at the risk of a prolonged and terrible death — which was precisely what he got,” Dr. Gawande writes.
Such things happen because modern death-delaying techniques are relatively new in medicine. Which patients have long-term life-threatening conditions and which are really at death’s door? In what Dr. Gawande calls “an era in which the relationship between patient and doctor is increasingly miscast in retail terms,” how easy is it for doctors — trained to solve problems and succeed — to acknowledge that there’s no cure to be had? How many doctors, used to telling their patients how to live, are ready to talk to them about how to die?
Dr. Gawande’s early description of how the body decays with age is nothing if not sobering. It’s one thing to know that arteries harden; it’s another to learn that he, as a surgeon, has encountered aortas so calcified that they crunch. And so it goes with this book’s thorough litany of body parts, from the news that an elderly person’s shrinking brain can actually be knocked around inside his or her skull to the way a tooth can determine a person’s age, give or take five years. Eat and exercise however you want, tell everyone how old your grandparents lived to be: According to “Being Mortal,” none of these factors do much to slow the march of time. (...)
“Mainstream doctors are turned off by geriatrics, and that’s because they do not have the faculties to cope with the Old Crock,” says Dr. Felix Silverstone, a specialist in the field. To summarize: This hypothetical Old Crock is deaf and forgetful, can’t see, has trouble understanding what the doctor says and has no one chief complaint; he has 15 of them. He has high blood pressure, diabetes and arthritis. “There’s nothing glamorous about taking care of any of those things.”
But patients who receive good geriatric care stay happier and healthier, just as old people who can remain at home and aren’t forced into nursing homes are better able to enjoy their lives. This book makes a thorough inquiry into how the idea of the assisted-living facility arose as a supposed improvement on regimented nursing homes but has often become a disheartening place for independent-minded people to have to go. The all-important quality-of-life issue that is used to market such places, Dr. Gawande maintains, is directed more toward the people planning to leave Mom then than toward Mom herself. But he sees a lot of hope in the group living concept, if it is overseen with the residents’ happiness in mind.
Such things happen because modern death-delaying techniques are relatively new in medicine. Which patients have long-term life-threatening conditions and which are really at death’s door? In what Dr. Gawande calls “an era in which the relationship between patient and doctor is increasingly miscast in retail terms,” how easy is it for doctors — trained to solve problems and succeed — to acknowledge that there’s no cure to be had? How many doctors, used to telling their patients how to live, are ready to talk to them about how to die?
Dr. Gawande’s early description of how the body decays with age is nothing if not sobering. It’s one thing to know that arteries harden; it’s another to learn that he, as a surgeon, has encountered aortas so calcified that they crunch. And so it goes with this book’s thorough litany of body parts, from the news that an elderly person’s shrinking brain can actually be knocked around inside his or her skull to the way a tooth can determine a person’s age, give or take five years. Eat and exercise however you want, tell everyone how old your grandparents lived to be: According to “Being Mortal,” none of these factors do much to slow the march of time. (...)
“Mainstream doctors are turned off by geriatrics, and that’s because they do not have the faculties to cope with the Old Crock,” says Dr. Felix Silverstone, a specialist in the field. To summarize: This hypothetical Old Crock is deaf and forgetful, can’t see, has trouble understanding what the doctor says and has no one chief complaint; he has 15 of them. He has high blood pressure, diabetes and arthritis. “There’s nothing glamorous about taking care of any of those things.”
But patients who receive good geriatric care stay happier and healthier, just as old people who can remain at home and aren’t forced into nursing homes are better able to enjoy their lives. This book makes a thorough inquiry into how the idea of the assisted-living facility arose as a supposed improvement on regimented nursing homes but has often become a disheartening place for independent-minded people to have to go. The all-important quality-of-life issue that is used to market such places, Dr. Gawande maintains, is directed more toward the people planning to leave Mom then than toward Mom herself. But he sees a lot of hope in the group living concept, if it is overseen with the residents’ happiness in mind.
by Janet Maslin, NY Times | Read more:
Image: Tim Llewellyn
