Gerontology 8000
Critical Reflection # 1
Being Mortal
Atul Gawande
Introduction & Chapter 1: Being Independent
Introduction
I obtained this book two days before our first class, and read it cover to cover. The topic is of great interest to me given my age and other factors I discuss later. Gawande’s introduction confirms what I have heard for years; medical school does not spend much time teaching physicians how to deal with the dying process. According to Gawande, the “purpose of medical school was to teach how to save lives, not how to tend to their demise.” While doctors are expected to be knowledgeable, honest and sympathetic, a few years into his practice, the author realized how unprepared he was to provide support to patients facing their finality. Being Mortal deals with aging and dying in today’s world. Medical advances and technology have changed this experience compared to what previous generations encountered. Life ultimately ends for everyone, and Gawande’s goal is to help improve the ability to help individuals and the people around them get the most quality time possible during this final phase.
To me the introduction deals with the medical profession’s “bedside manner”. There’s a story where a physician says to the patient, “I’ve got bad news and really bad news. The bad news is you’ve only got six months to live.” The patient said, “Gee, what could be worse than that?’ The doctor replied, “I should have told you three months ago.” Hopefully this was a joke, but I believe many health care professionals could improve their communication, especially when issues become tough and unsolvable from a medical standpoint. Most professionals—even outside of medicine—are trained to accomplish tasks and achieve goals. When the problem becomes unsolvable, frustration and fear threatens us. However, many issues are unsolvable and eternal life is one of them. Throughout the book Gawande offers suggestions on how discussions about the final stages of life could be handled more appropriately.
Chapter 1: The Independent Self
I relate to this chapter for many reasons. I am 71 years old, and have lived alone for over 25 years. My only close family is my 69-year-old brother who lives in Olympia, Washington, and a 41-year-old stepson in Phoenix. Although I have 20 cousins all over the country, none of them are within 700 miles. I have been physically active all my life, cycle an average of 4,000—6,000 miles a year and do strength workouts 2-3 times a week. I am in good health despite arthritis and gastroeshageal reflux disease. My only medication is 20mg/day of omeprazole (OTC for GERD). I’ve had numerous orthopedic surgeries including total joint replacements on both left and right knees and hips.
The stories of Alice Hobson, the author’s father and grandfather, and other individuals in later chapters remind me the only way independence lasts a lifetime is if a person has a sudden, swift demise, i.e. accident or heart attack. Most of us will lose complete independence at some point before we die. During recovery from several surgeries, I relied on friends to help with tasks like driving and shopping. Most of the time I astonished friends and physicians with my ability to regain normal functions, but as I read Being Mortal I realize there are no guarantees about remaining independent; something can always snatch that away.
Gawande mentions Del Webb, who developed Sun City, one of the earliest communities strictly for retirees. While they have become popular, many individuals, Alice Hobson for example, wanted to stay in their own home as long as possible. I reviewed a 2014 study which examined how older adults address issues of planning for future living conditions when not under pressure to do so. The bottom line is most of them did not. A recurring theme in several Being Mortal stories is how much individuals forced into assisted living or other facilities missed familiar surroundings.
Upon reflection, I think individuals should consider communities or surroundings that offer independent and/or assisted living services while they are still independent. That could provide an opportunity to design living conditions that would accommodate some declines in independence while providing time for an individual to make it become and feel like “home” instead of a “place”. I downsized and simplified my living situation about 10 years ago. One thing I did though was buy a condominium with three flights of stairs from my garage. I did this on purpose since I felt climbing 51 stairs keeps me moving especially given my osteoarthritis. Reading Atul Gawande’s book helped me realize I should consider additional steps (perhaps a place with an optional elevator) that would provide some flexibility if or before my situation changes.
Monday, August 28, 2017
Monday, July 24, 2017
Back to the Future--Smokey Chattin
My long time friend Smokey Chattin died last Saturday on his 71st birthday. He is the first person to die that I knew and saw regularly for nearly 60 years.
I became friends with Smokey in high school when he dated my next door neighbor, Bonnie Brown. Ironically I wound up becoming friends with a lot of guys when they dated Bonnie. I didn't see much of him during my college years, but in the fall of 1968 we both wound up in Atlanta. I was on a temporary assignment with Chubb and Smokey was with Crawford & Company training to be a claims adjuster. I'd like to think that we related to each other then since we were both involved with the insurance industry, but in fact it was most likely chasing women and alcohol that bonded us. I may have those in the wrong order.
In the early 1970's I was back in Atlanta and Smokey was in our hometown (Danville). I visited Danville regularly to see my mother and we hung out together still pursuing our similar dual interests. Then Smokey met and married Liz Newton. They moved to Blacksburg and Smokey went back to school at Virginia Tech. He had started there previously but dropped out after a few semesters. He graduated, went to work in the banking business and built a new house for he and Liz. They visited me while I was in New Jersey and all seemed great.
But it apparently wasn't. The thing about Smokey was that he was intelligent, good looking, and a charmer but there was a self destructive dark side to Smokey which wound up disappointing and frustrating a lot of people who cared for him. And when things went south you really had to take Smokey's explanation with a grain of salt. I hadn't figured that out when his marriage dissolved. That pattern was repeated over the years. At times Smokey seemed like he was on top of the world and then everything would fall apart. I won't go into detail on all those episodes except to say that throughout the 1980's, 90's and beyond we remained friends and saw each other regularly since we both lived in Georgia. I may be one of the few persons really close to Smokey who never directly experienced the frustration with him that others did. He did approach me a few times asking for a favor. By the time that happened though I was pretty cautious and didn't do anything that would have cost me financially or negatively affect our friendship.
I previously mentioned our common bonds and one similarity we shared was a long term dependency on alcohol. One reason I ultimately quit drinking seven years ago was being around Smokey and realizing that alcohol was negatively affecting both of us. Once I quit it was harder to be around Smokey. In fact over the last few years the only time I spent time with him was our 50th high school reunion. We also got together for dinner with two other friends the following evening. I could tell he was not in good physical condition. Life had clearly taken a toll on him. Early last year Smokey suffered a major stroke that left him paralyzed on his right side and unable to even speak. I visited him several times in an assisted living facility here in Atlanta and for a while he improved; he could talk and use his right hand. However, it was clear he would probably never be able to live on his own. His older sister Bonnie was about the only family he had left and she lives in California; her hope was he would progress to the point where she could move him to an assisted living home out there. She visited several times and then Smokey wound up back in the hospital. He left the hospital but neither they or the assisted living home knew where he was. I checked in with Bonnie and found out Smokey was in another facility and had deteriorated to the point where hospice was coming in to evaluate. I went to visit the next day and it was tough. I wondered whether he could even last until Bonnie returned in a few days.
Bonnie along with his niece arrived to find out Smokey was back in the hospital on a ventilator. All three of us thought the end was near, but when they removed the ventilator, a decision made by Bonnie who realized he was suffering, he survived and wound up back in assisted living. On his 70th birthday last year, Bonnie came to Atlanta and organized a birthday celebration for Smokey at the assisted living facility. A lot of his Atlanta friends came and Smokey was in good spirits, but to me it was obvious by then he was never going to leave that facility alive.
I went by to see him a few times after that but he was deteriorating. He weighed well under 100 lbs, couldn't really eat solid food, and at times seemed to be in a vegetative state. To be honest it became too painful to watch the downward spiral and like several times before in our relationship I avoided going to see him. In fact the last time I visited I thought he was actually dead; finally I saw his chest barely move. He was alseep so didn't even speak to him. I found out he passed away when his daughter and some friends posted it on Facebook.
As I mentioned Smokey had huge potential and I observed him crashing, but then resurrecting himself like the Phoenix. He could have done almost anything career-wise and been successful. From banking to insurance to sales to becoming a master craftsman building and renovating homes the world could have been his oyster. There's no doubt that his lifestyle ended up cutting his life short. Godspeed Claude "Smokey" Chattin. I am grateful to have known you and happy that you are no longer suffering.
I became friends with Smokey in high school when he dated my next door neighbor, Bonnie Brown. Ironically I wound up becoming friends with a lot of guys when they dated Bonnie. I didn't see much of him during my college years, but in the fall of 1968 we both wound up in Atlanta. I was on a temporary assignment with Chubb and Smokey was with Crawford & Company training to be a claims adjuster. I'd like to think that we related to each other then since we were both involved with the insurance industry, but in fact it was most likely chasing women and alcohol that bonded us. I may have those in the wrong order.
In the early 1970's I was back in Atlanta and Smokey was in our hometown (Danville). I visited Danville regularly to see my mother and we hung out together still pursuing our similar dual interests. Then Smokey met and married Liz Newton. They moved to Blacksburg and Smokey went back to school at Virginia Tech. He had started there previously but dropped out after a few semesters. He graduated, went to work in the banking business and built a new house for he and Liz. They visited me while I was in New Jersey and all seemed great.
But it apparently wasn't. The thing about Smokey was that he was intelligent, good looking, and a charmer but there was a self destructive dark side to Smokey which wound up disappointing and frustrating a lot of people who cared for him. And when things went south you really had to take Smokey's explanation with a grain of salt. I hadn't figured that out when his marriage dissolved. That pattern was repeated over the years. At times Smokey seemed like he was on top of the world and then everything would fall apart. I won't go into detail on all those episodes except to say that throughout the 1980's, 90's and beyond we remained friends and saw each other regularly since we both lived in Georgia. I may be one of the few persons really close to Smokey who never directly experienced the frustration with him that others did. He did approach me a few times asking for a favor. By the time that happened though I was pretty cautious and didn't do anything that would have cost me financially or negatively affect our friendship.
I previously mentioned our common bonds and one similarity we shared was a long term dependency on alcohol. One reason I ultimately quit drinking seven years ago was being around Smokey and realizing that alcohol was negatively affecting both of us. Once I quit it was harder to be around Smokey. In fact over the last few years the only time I spent time with him was our 50th high school reunion. We also got together for dinner with two other friends the following evening. I could tell he was not in good physical condition. Life had clearly taken a toll on him. Early last year Smokey suffered a major stroke that left him paralyzed on his right side and unable to even speak. I visited him several times in an assisted living facility here in Atlanta and for a while he improved; he could talk and use his right hand. However, it was clear he would probably never be able to live on his own. His older sister Bonnie was about the only family he had left and she lives in California; her hope was he would progress to the point where she could move him to an assisted living home out there. She visited several times and then Smokey wound up back in the hospital. He left the hospital but neither they or the assisted living home knew where he was. I checked in with Bonnie and found out Smokey was in another facility and had deteriorated to the point where hospice was coming in to evaluate. I went to visit the next day and it was tough. I wondered whether he could even last until Bonnie returned in a few days.
Bonnie along with his niece arrived to find out Smokey was back in the hospital on a ventilator. All three of us thought the end was near, but when they removed the ventilator, a decision made by Bonnie who realized he was suffering, he survived and wound up back in assisted living. On his 70th birthday last year, Bonnie came to Atlanta and organized a birthday celebration for Smokey at the assisted living facility. A lot of his Atlanta friends came and Smokey was in good spirits, but to me it was obvious by then he was never going to leave that facility alive.
I went by to see him a few times after that but he was deteriorating. He weighed well under 100 lbs, couldn't really eat solid food, and at times seemed to be in a vegetative state. To be honest it became too painful to watch the downward spiral and like several times before in our relationship I avoided going to see him. In fact the last time I visited I thought he was actually dead; finally I saw his chest barely move. He was alseep so didn't even speak to him. I found out he passed away when his daughter and some friends posted it on Facebook.
As I mentioned Smokey had huge potential and I observed him crashing, but then resurrecting himself like the Phoenix. He could have done almost anything career-wise and been successful. From banking to insurance to sales to becoming a master craftsman building and renovating homes the world could have been his oyster. There's no doubt that his lifestyle ended up cutting his life short. Godspeed Claude "Smokey" Chattin. I am grateful to have known you and happy that you are no longer suffering.
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