Being Mortal: Medicine and What Matters in the End by Atul Gawande
“This is the best time of your life!” ~ “The world is your oyster!” ~ “You have the world at your feet!”
“You’re never too old to look younger.” ~ “It’s time to say goodbye to aging skin.” ~ “Stay young forever.”
These quotes are carved into our culture so deeply that we know them by heart. Youth - why is that our desire when we’re clearly moving farther and farther away from it? Why do we discuss childhood, adolescence, and adulthood as the main stages of life? Why is it so difficult to not only acknowledge, but to embrace the final stage of life - elderhood? My spell check underlines the word since it isn’t in our current dictionary. Why is that? AntiAging is a word, ironically.
“In this world, nothing is certain except death and taxes.”
I am passionate about caring for the aging with respect and dignity. My view and perspective has changed over time. I am years away from dying (statistically speaking, that is), but I feel a strong desire to seek out how to best care for the generation before me. I am older than I used to be (obviously!). I have had the opportunity to work with hospice, with palliative care, and with memory care clients. I have recently lost my mother-in-law to a variety of health issues. Most importantly, perhaps, I am always one day closer to that same place myself - death.
Being Mortal
I acknowledge that this is a morbid way to begin a post about my thoughts on a book that has influenced my view of elderhood, but it is true. Being Mortal by Atul Gawande was recommended to me by a friend (thanks, Julie!). I listened to it in my car, on my way to see hospice patients. The book captivated my attention, and I began listening from a clinical, healthcare perspective. I found, however, that the more I became wrapped up in Gawande’s thoughts and ideas, I was listening from the perspective of a daughter, a granddaughter, a sibling, a friend.
Everyone reading this article can identify with death and dying in some capacity - whether we have been directly affected by death, or whether someone close to us has been affected by it. As a hospice music therapist, I spend a considerable amount of my time initiating conversations surrounding this topic. I used to steer clear of it in conversation, and don’t get me wrong, it is not my typical conversation starter at a party. :) Nonetheless, there is something liberating about having the discussion surrounding end of life, especially when it centers around specific wishes of someone you love most at the end of his/her life.
Atul Gawande, surgeon and author of the book Being Mortal, asks questions that I believe are essential - not only at end of life but much earlier than that. He argues that establishing our “line in the sand” is not only essential for the person with ailing health but for those who provide care and make healthcare decisions for that person.
Gawande tells the stories of physicians, academics, and family members who are challenging and revolutionizing age-old questions surrounding quality, dignified care for the aging.
The First Assisted Living Facility
Keren Brown Wilson pioneered the first assisted living facility, inspired by her mother.
Gawande talks with Keren Brown Wilson. In the 80’s Wilson wanted something more for her mother than the nursing homes available at the time. Wilson’s mother wanted her own kitchen, bathroom, her favorite things (most importantly, her cat!), her unfinished projects, her coffeepot, and her cigarettes. Her mother also acknowledged that she needed assistance but did not want to sacrifice her independence.
Wilson came up with the vision of an assisted living facility. Sadly, many assisted living facilities today are not a clear picture of what she first created and envisioned. In the book, Wilson states, “Nothing that takes off becomes quite what the creator wants it to be.”
“Nothing that takes off becomes quite like the creator wants it to be.”
Wilson was the first to ask, “how can ordinary people age without having to choose between neglect and institutionalization?” and then do something about it. Her original assisted living facility was a success, it was profitable, and it seemed to be the ideal solution. Once the idea caught on, however, companies took the idea and created enormous facilities that were counterintuitive to Wilson’s original vision of providing that feeling of being at home.
Reimagining the “Traditional” Nursing Home
Gawande also talks with Dr. Bill Thomas, a young physician in upstate New York in 1991 who conducted an experiment. He argued that a “good life was one of maximum independence.” As the medical director of the nursing home, he argued that this was “precisely what the people in the nursing home were denied.” Dr. Thomas had a vision to put life into the nursing home - literally - plants, animals, and children. He outlined a proposal to attack the “Three Plagues” of nursing home existence: boredom, loneliness, and helplessness. Included in his proposal were two dogs, four cats, 100 birds, and an outdoor garden.
William H. Thomas, M.D. is an international authority on geriatric medicine and eldercare. Dr. Thomas' groundbreaking work in person-directed care led him to imagine a new approach to long-term care that became known as the Green House.
When questioned by skeptics (or realists, as I would call them), “Have you ever lived in a house that has 2 dogs, 4 cats, and 100 birds?!” Thomas’s response was, “No, but wouldn’t it be worth trying?!”
I am by nature an “inside the box” type of thinker. Thanks to influencers and mentors in my life, I am pushing myself to think more and more “outside the box.” Gawande allows the reader to not just dream about the possibilities, but to see dreams come true as a result of visionaries and a lot of hard work to push against the accepted standards of care.
A colleague once told Keren Brown Wilson, “We want autonomy for ourselves and safety for those we love. Many of the things that we want for those we care about are the things that we would adamently oppose for ourselves because they would infringe upon our sense of self.” Wilson tells Gawande that it is the rare child who is able to think, “Is this a place that Mom would want or like or need?” rather than “Is this a place that I would be comfortable leaving Mom?”
There is so much more to the book than what I shared in this post; I hope it has inspired you to check it out. I am so grateful to my friend for telling me about it. Upon further researching this topic, I came upon a book Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life by Louise Aronson. I can’t wait to see what it has to say about the topic of how to best support and care for our aging population.
What are you reading or learning about that excites you and moves you to change? Please reach out to me and share your thoughts! Let’s keep the conversation going - it’s through reading and discussion that we affect change in our world.