Being Mortal (Book)
Being Mortal
"Medicine and What Matters in the End"
Being Mortal by Atul Gawande is a truly thought-provoking book. He has questioned the healthcare system to its core. One of the things I truly enjoyed about this book was that it emphasized more on the well-being of the patient than simply their health and survival. As people in the healthcare sector, our job isn't simply to prolong life, we have to ensure that people are living a meaningful life as well.
In the previous century, there was a lack of medicine and treatment options. People used to live till their 50s. They could die of simple diseases such as Malaria or dengue. Any bacterial infection used to cause severe degradation in health. With advancements in health care, life expectance increased. People lived longer. They began to experience old age. Old age comes with various ailments.
Humans are mortal. We all will die eventually. As we come to our natural end, we experience various problems. These may include backache, memory loss, muscle weakness, falls, depreciation in vision, deafness, and many more. Come to a doctor with any one of these problems and he/she will have a treatment plan, but come with the whole range of problems and old age, the doctor is kind of lost. The patient will end up with tons of medications and quite a bit of side effects. The quality of life is affected. In today's world, the concept of a joint family is getting lost. People opt to work in faraway places and get an education abroad. Hence, families are no longer able to care for the old in the way it was possible in earlier times. This has led to the emergence of nursing homes, assisted living facilities, and retirement homes. The book, Being Mortal talks about the difference in these and their evolution over time.
In the case of terminally ill patients, there is rarely any time a doctor says they cannot do anything. For example, a patient having cancer can undergo surgery, followed by radiation, various series of chemotherapy, and immunotherapy. Yet, doctors won't give up. They would still have treatment options to offer the patient. They are purely focused on prolonging life, not realizing they are increasing the suffering as well. Meanwhile, the patients are waiting for the doctor to say that can't do anything. This situation doesn't arise and as a result, people die suffering. The loved ones don't get a chance to say goodbye and families suffer from pangs of depression and trauma throughout their lives.
It is the responsibility of the doctor to ensure that the patient knows all their options including the option of not opting for any treatment but instead going for palliative care. The doctor is also responsible for advising the patient when it's best to stop treatment and spend time with family. This is not as easy as it seems. The patient and the family might become demotivated but then the end won't come as a shock and the rest of the life can be spent in the way that the patient wants to instead of spending months in the hospital hoping for a miracle. It will be a very difficult conversation asking about the goals they want to achieve before their death, the trade-off they are willing to make and the extent to which they want to get treated, and when it's enough for them. However hard this conversation seems, it's always worth it.
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