In the wake of the NRSH Kolkata events, the death of an 85-year-old patient has easily divided us into 2 groups- one supporting the injured young intern(most of the medical fraternity) and the other supporting the patient’s relatives. We are out there running media trials against doctors, asking for security, blaming the government with the real problem growing every minute – our hope. We have in our heads magnified our hopes that medical science can fix anything, even death; so much that death instead of seeming natural is translated into the doctor’s incompetence today.
As Dr Atul Gawande has succinctly said, ‘In the past few decades, medical science has rendered obsolete centuries of experience, tradition and language about our mortality and created a new difficulty for mankind: how to die’
Being Mortal, by an American surgeon Dr Atul Gawande, is a careful and sensitive insight into this non-fixable problem faced by modern medicine today, with the backdrop of ageing and inescapable realities. As the author’s father comes face to face with a terminal illness, Dr Atul sets on a journey, only to discover the deficiencies of medical establishments in the end-of-life care and patients’ expectations out of the process/treatment.
‘Ninety-nine per cent understand they are dying, but one hundred per cent hope they’re not…they still want to beat the disease.’
The book is divided into eight beautifully elaborated chapters that follow a trajectory from Independence (“would not want to die with ventilators and nurses by my side”) to Death (“Don’t you give up on me just yet”/ “you give me every chance I got”). Though the book fearlessly talks about the struggles of the medical profession, it also highlights the need for correct guidance for the patient to accept his reality and not succumb to his hope of going back miraculously to his ailment, ageing-free self.
Dr Atul Gawande’s honest and humane observations of his patients’ life and priorities will inculcate a certain depth to your thoughts and attitude towards life, elderly and for that matter even your own parents. What is really impressive here is the doctor’s storytelling skills with no advice or preaching, just laying out the facts as they are for you to read.
‘The simple view is that medicine exists to fight death and disease and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war you cannot win, you don’t want a general who fights to the point of total annihilation….someone who understands that the damage is the greatest if all you do is battle to the bitter end.’
To my medical friends, the book has lifted one weight off our chest by clearly pointing out and admitting that we are not prepared or are underprepared to embrace the circle of life with integrity. We are so focused on repair and fixing the problem at hand that we have forgotten to take out the time and talk to our patients about their purpose and priorities in life. Without knowing or interacting with the patient what tradeoffs he/she is willing to undertake, how do we even put together the right treatment plan?
Doctor-patient relation, geriatrics and the humane side of medicine are topics that are most often not even touched upon in our medical educational institutes. This book has questioned not only our teaching but also our approach towards ageing, ailment and even death. It has addressed the omnipresent struggle to retain the autonomy of one’s life even in the face of illness and disease and how safety in old age should not boil down to no freedom.
Apart from the innumerable questions, this book raises in our minds the most important being…
“People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have hard discussions and say what they have seen, who will help prepare people for what is to come….”
Will we be able to be the above kind of doctors? Will we be accepted by society if we become the above kind of doctors?
