Columns

Two new (2014) books:

Atul Gawande (1965- ). Being Mortal: Medicine and what matters in the end.

Donald Hall (1928- ). Essays After Eighty.



Frontline’s Feb. 10, 2015 program was based on Dr. Atul Gawande’s book, Being Mortal: Medicine and What Matters In The End. Gawande’s fields are journalism, public health, and surgery.

He must have been in his late forties when he wrote this book about the modern experience of mortality. Born in Brooklyn, New York, he went to Stanford for his B.S., Oxford for his M.A., and Harvard Medical School. He has been both a MacArthur Fellow and Rhodes Scholar.

“Mortal” is an adjective relating to human beings subject to death. It is also used to mean deadly, fatal. Gawande writes, this is a book “…about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong.” When doctors and patients talk death, hope is not a plan. The goal of medicine should not be a good death, but rather, a good life to the very end. 

Mainstream doctors are turned off by geriatrics. “…incomes in geriatrics and adult primary care are among the lowest in medicine…a lot of doctors don’t like taking care of the elderly.”  

Health professionals have a classification system for the level of function that a person has. If you cannot, without assistance, perform the 8 Activities of Daily Living (use the toilet, eat, dress, bathe, groom, get out of bed, get out of a chair, and walk ,) then you lack the capacity for basic physical independence. The Independent Activities of Daily Living are shop, prepare food, housekeep, laundry, manage meds, phone calls, travel on your own, handle your finances. 

The field of palliative care emerged over recent decades to bring this kind of thinking to the care of dying patients. …But it is not cause for celebration. That will be warranted only when all clinicians apply such thinking to every person they touch. No separate specialty required.  

Admission to hospice care is restricted. Hospice is a care philosophy based on belief that every person with a life-limiting terminal illness, regardless of age, is entitled to be as free of pain and symptoms as long as possible. Some folks, including “professionals,” assume that hospice provides assisted suicide. It is currently possible to obtain physician-assisted suicide, albeit not easily, in three states. Popular literature conveys two pictures of hospice-- an at-home service and a building/program elsewhere. It can be confusing. 

Dr. Gawande is saying what matters in the end is the life led. 

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Essays After Eighty is, according to Publishers Weekly’s starred review, loaded with insights into the human condition. Jane Gross comes closer with her New York Times “Growing Older, Not Happier” review.  

Donald Hall was born in 1928, placing him in his early eighties while compiling these essays. He has led a life of letters (book jacket) in academe and on the road with poetry readings. He resigned after a year as Poet Laureate. “When I was young I could project, and now without a microphone I can’t be heard in the tenth row… the debility of age.”  

There have been several hirsute adornments (phases, seemingly) and wives, two children, divorce, cancer, New Hampshire… The book jacket consists of a close-up view of an aged face with bushy eyebrows and bulbous nose. Hall apparently has always had beards or not shaved.  

The linguistics of Hall’s “Death” essay initially appealed to me-- he starts right off with “I will not pass away.” Right on! No euphemisms for me either. He continues “… My problem isn’t death but old age. I fret about my lack of balance, my buckling knee, my difficulty standing up and sitting down.” Working for and on him are four women in their fifties. One is a trainer. One “keeps the house. She washes my clothes, she drives me to the doctor. She arranges my furniture for comfort and safety.” 

On divorce: “The marriage lasted fifteen years, ending in 1967. Divorce was miserable, as it always is, and we divorce for the same reasons we marry. … Yet to my surprise and gratitude, it [her cancer] brought us together again, and it was a comfort [for him] to sit beside her and reminisce” as she died.  

On hospice: Some fortunate people die in a hospice, which is tender but brief. …Some hospitals perform palliative care for the terminally ill. Others of us still die at home…These days most old people die in profit-making expiration dormitories. Their loving sons and daughters are busy and don’t want to forgo the routine of their lives. One said he would not diaper his parents—so he handed them over to women who diapered at the minimum wage.  

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Senator Dianne Feinstein has endorsed California’s assisted-suicide bill. “The right to die with dignity is an option that should be available for every chronically suffering terminally ill consenting adult in California,” Feinstein, D-Calif., wrote in a letter to the authors of SB 128, the End of Life Option Act. “I share your concern that terminally ill California residents currently do not have the option to obtain end-of-life medication if their suffering becomes unbearable.”