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.
