November 20, 2014

Surgeon and Author Atul Gawande on What REALLY Matters at the End of Life

"People with serious illness have priorities besides simply prolonging their lives.Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The question therefore is not how we can afford this system’s expense. It is how we can build a healthcare system that will actually help people achieve what’s most important to them at the end of their lives."
--Atul Gawande, from Being Mortal: Medicine and What Matters in the End

<>  <>  <>  <>  <>  <>  <>

Atul Gawande is a highly respected surgeon and a writer for The New Yorker. His powerful and moving new book -- Being Mortal -- was number four on last Sunday's New York Times bestseller list for nonfiction.

He describes in vivid, heart-wrenching detail the final days of patients who are often in such denial of their imminent deaths that they, or their families, demand futile lifesaving measures. Meanwhile, his own profession treats aging, frailty, and death as if they were simply clinical problems to solve.

Usually at this point in blog posts I would go on -- and on and on -- summarizing the book's message. But I have a new resolve to shorten my posts. More compellingly, Gawande has provided his own excellent descriptions during recent interviews, and he is far more articulate than I am. There are several wonderful interviews at the end of this post.

Something Gawande described was especially interesting to me -- the questions he asked his own father, also a surgeon, in his final days. These questions come from the work of Susan Block, an expert in palliative medicine.

  1. What is your understanding of what is happening to you?
  2. What are your fears about what is happening?
  3. What are your goals if your condition worsens?
  4. What trade-offs are you willing to make and not willing to make to try to stop what is happening?

I'll try to answer those questions myself in a future post.

Now... several excellent interviews with Dr. Gawande. In my own viewing of video clips on the web and with my short attention span, I always look first at how long the video runs. It has a chance of my watching it if runs less than five minutes. Ten minutes, top.

This interview takes over an hour. At first, I began playing it in the back ground while doing something else on the computer. Within a few minutes, I was giving it my full attention.

Here's Jon Stewart's interview, shorter (about seven minutes) and funnier:

Finally, here's the Frontline interview, just over three minutes long.


sunnysouth said...

Thank you for posting, John.

Anna said...

Yes, I thank you, too. We so need to talk about death and dying. It should start much earlier in life than it does for even those few who *ever* think deeply about it. I will be reading Dr. Gawanda's book and sharing these links with everyone I care about.