Living a Good Life to the Very End | Thoughts on “Being Mortal” by Atul Gawande

“In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality and created a new difficulty for mankind: how to die.” — Atul Gawande

Being Mortal: Medicine and What Matters in the End by Atul Gawande is a phenomenal book on the shortcomings of modern healthcare and the importance of encouraging actions and ideas that makes it possible to lead a good life to the very end.

Throughout the book, Gawande recounts several personal stories about patients and family members who went through the healthcare system at the very end of their lives. With great passion and care, he takes us with him to explore the fragile nature of human life.

And through this very personal vantage point, I feel great connectedness and relatability to the ideas that are being shared therein.

The hallmark of a great book, in my opinion, is that it inspires deep thoughts and reflection in the reader, and that is what Being Mortal did to me.

But then again, It can be hard to reflect on death and ultimately our own mortality, but it can be very liberating as well. By reading this book and having hard conversations, I have earned greater respect and understanding of human life and its preciousness.

Among many points of reflection, I have chosen to discuss these three.

  • Multigenerational healthcare Vs. institutionalized healthcare
  • What does “care” in healthcare stand for?
  • Freedom to make bad decisions

Multigenerational Healthcare VS Institutionalized Healthcare

“But one thing he could never get used to was how we treat our old and frail — leaving them to a life alone or isolating them in a series of anonymous facilities, their last conscious moments spent with nurses and doctors who barely knew their names.” — Atul Gawande

The “he” referred to in this quote is the author’s father, Atmaram Gawande. He saw immense cultural differences in healthcare between India (where he was born) and America (where he was now a proud citizen).

Elderly people, where he was from, were not sent away to nursery homes. Instead, they lived and home and were taken care of by their families, who lingered by their sides to the very end. Multigenerational systems were set in place, often with many generations living under the same roof.

The old man, surrounded by a loving family day in and day out. Yes, that’s a nice and romantic image that many of us think we’d like for our own parents. But. There is a but.

We don’t actually want it.

Because it means that we would have to “sacrifice” our personal freedom only to live 24/7 with our parents, it’s the kind of thing we are happy to see someone else doing but are not willing to do ourselves.

Modern societies have developed institutional healthcare systems. In these systems, professionals take care of the old and frail 24/7, and this is definitely a better alternative as concerns prolonging life.

Still, it seems that advances towards institutional centration of healthcare have caused other problems to arise—specifically, problems concerning the quality of life.

What Does “care” In Healthcare Stand For?

“In a nursing home, the official aim of the institution is caring, but the idea of caring that had evolved didn’t bear any meaningful resemblance to what Alice would call living.” — Atul Gawande

“Alice” is Alice Hobson, the grandmother of Gawande’s wife. And her story ends on a particularly disheartening note as she sinks into depression and loneliness after losing her car, her home, and moving to a retirement facility at the request of her family.

At the nursing home, all privacy and control were gone. Instead, she lived according to a strict regime — waking, bathing, and dressing when she was told to, just like a hospital… or a prison. At least, that was how Alice described it. She felt like she was in prison for being old.

If there is anything a decent nursing home is built for, it is safety. But the trouble was that Alice wanted and expected more from life than safety. She wanted the freedom to make her own choices and, perhaps most importantly, a sense of purpose in her life.

Is being safe the same as leading a good life?

Alice did not seem to think that. For her, living was so much more.

So, while she was indeed cared for in one sense of the word, it was the kind of care that did not care for the person beneath the hospital gown.

Okay, but what’s the alternative?

Freedom to Make Bad Decisions

“The key word in her mind was home. Home is the one place where your own priorities hold sway. At home, you decide how you spend your time, how you share your space, and how you manage your possessions. Away from home, you don’t.” — Atul Gawande

Gawande does not give any definite solutions, but he does mention hospice & palliative care as options that are more humane and considerate of the individual. Hospice care is when you are taken care of at home, and palliative care is all about minimizing the pain and struggles of aging.

It is not always possible to stay at home. Still, there are many options, such as living in assisted living facilities that give the individual freedom to choose what they do with what they’ve got.

For instance, the freedom to make bad decisions.

They may not make the medically best decisions if free to choose themselves, but I still think they should still be allowed to decide.

Make them aware of the risks of certain behaviors, but do not force them to comply. For example, offer a wheelchair if it seems fit, but accept if they’d like to walk by themselves and continue working from that point.

What if they had lived for longer with optimal care and nutrition?

Well, of course. We have lived our entire lives aware of this, drinking alcohol and eating crap when we feel like it, despite it not being the best for us, so why would this change when we are at the end of our lives?

Sure, there is a larger risk of health defects due to bad nutritional and habitual choices because one may be close to death, but it’s not all about extending life.

It’s about living a good life to the very end; it’s about ensuring that our last days are also among our happiest.

Thanks for reading this piece! I would love to discuss the subjects I’ve discussed in this article further, so please do not hesitate to share your thoughts in the comments (:

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