Being Mortal

Being Mortal: Medicine and What Matters in the End
By Atul Gawande (282 pages)
Published by Metropolitan
Bookish rating: 4

Despite being the bookish sort who loves herself a good fairy tale, I am weirdly interested in medicine. On the one hand, I hate it---I'm incredibly uncomfortable in hospitals, I dread visits to physicians, and I'm not a big fan of pain (but who is?). On the flip side, I'm fascinated by the inner-workings of health care (good thing, because my job involves publishing on behalf of HEALTH) and how decisions get made---and what those who are deciding actually think and feel.

Which is why I picked up Gawande's recently published book.

Gawande, a surgeon, examines aging, the process of approaching death (which may occur when you're young), and medicine's current trend to extend life while obliterating its quality. Gawande argues that part of this is due to doctors not being super upfront with patients about their prognosis. And as long as there's a chance, most people want to undergo treatments, no matter the side effects. Which is understandable. Death is scary.

The more interesting aspect of the book, though, is Gawande's exploration of aging---quite the important topic, as the "gray tsunami" of the retiring baby boomers threatens to ruin our economy (I kid, I kid---sort of.) At first, I feared this would be another judgy-judgy "we cast aside our elders" take, the sort that skewers modern Americans for not taking in every single aging person in their family. Oh, the selfishness! But Gawande points out that historically, even in collectivist societies, people living to really old age and actually NEEDING younger folk to care for them was quite rare. But now people live WAY longer. Moving in with the kids might be a decent option for some, but the stress of trying to raise a young family, take Ma or Pa to all their appointments, work, deal with the grouch who no longer is king of his own castle, the constant too-loud blaring of the news on TV--all of which gets exponentially worse as health fades---well, this is not a viable option for a lot of people.

Chris and I joke that we'd be screwed if we were expected to take in aging parents. Our folks span two generations. "Our house would be a nursing home for 40 years straight!"

However, Gawande exposes the flaws of the current assisted living facilities and nursing homes, and he does this very well. The loss of autonomy--not having a lock on your door, being subject to the facility's schedule, lack of children and animals to play with--these are not small things. Gawande describes different models of living arrangements that have been very successful in increasing quality of life, decreasing illnesses and medication use, AND saving money as a result. One hopes they become the norm.

I too was blinded by the pretty, upscale look of modern assisted living facilities. Where my grandmother lives outside Seattle, her place looks like a hotel. Big stone fireplaces, pretty earth tones, tinkling piano music. When she said she hated it, I blew her off as being her typical crankball self. I thought, it's so NICE! But Gawande points out that these places are marketed toward the younger folk who are helping an aging parent find a place to live. They walk in and think, it's so pretty! What a lovely place to live!

But people--young or old--need to be able to set their own schedules, socialize on their own terms, care for pets, have meaningful things to do (not silly time-fillers), and continue involvement in their communities (churches, clubs, etc.) BEYOND the care facility. A pretty lobby and around-the-clock falls prevention that circumscribes life even further does not make for a joyful existence.

I think young people need to read this book. Assisted living is a relatively new concept, and despite a good effort by our parents' generation, I think we need to make sure we revamp it for OUR aging parents. For example, I know my mom pretty well. There best be a dog wherever she ages.

Next, aging in place. The vast majority of people want to stay in their own homes as they age. A lot can be done to extend the time they live at home, promoting higher quality of life, and Gawande could've discussed this a bit more. I'm only 34 and whatnot and I'm decades out from figuring out how I'll live my last years, but I know even now that I'll want to live at HOME for as long as humanly possible. Most people do, and this is a desire that should be honored. Gawande describes a neighborhood or town whose older adults pay sort of small fee, and a handyman visits all their houses periodically to go up on ladders to change light bulbs or air filters, or fix this or that. I think housekeepers come and do things like mopping. This was organized at the community level and was so popular, it ballooned into hundreds of participants. Accessible homes and grab bars are nice and a good start, but quality of life, independence, and autonomy are crucial. SURELY we can find ways to keep people living in their own homes longer, if that is their desire.

Huh. This post turned out preachier than I intended. Anyway, read the book. Highly recommended.