Atul Gawande is a surgeon who shares experiences that led to his learning the nuances of “the conversation” – that talk doctors have, or avoid, when a patient faces a terminal diagnosis. What is the person’s desire? What are the desires behind the desire? “The talk” is not only difficult, it’s complex. And very important.
It is no secret that as modern medicine advances, it also creates major conflicts about facing infirmity, aging, and death. Dr. Gawande does this so artfully that I find myself recommending the book to anyone who expects to die one day.
Were many of us aware that aging is not simply a choice between toughing it out at home alone, or going to the sterile environment found in many nursing homes?Numerous options exist for staying in one’s home while getting help, through creating neighborhood support. Beacon Hill Village (in Boston) is one such group, Athens Village (in Ohio) is another. The Eden Alternative was conceived in a nursing home environment, and its principles can now be accessed across numerous settings (www.edenalt.org).
These are not options limited to the very wealthy; they are designed to keep costs within the budget of each individual (yes, including Medicaid), as well as to encourage maximum independence. Some assisted living facilities have created “family settings” consisting of about a dozen or so rooms centered around a community kitchen. What a refreshing change from taking Grandma to live at a new place, and she winds up having lunch with about 100 of her “newest friends!”
Nowadays it is not unheard of for a facility to have pets. Or to combine elderly day care with preschool programs. Or for elders to tutor school-age children–with a benefit to both that extends far beyond academics. “Being Mortal” deals with many hard questions. And it offers hope. Dr. Gawande has created a gift for all who choose to read this book.