“Being Mortal” - It's A Matter of Life and Death

Lawrence J Danks

Assistant Professor of Business - Camden County College

April 13, 2016

(I wrote this article eight years ago. I’m re-publishing it now because there is such great value in Dr. Gawande’s book and his very wise and experienced advice.)

Atul Gawande is a surgeon at Brigham and Women's Hospital in Boston. He's written a number of best sellers and appeared on "Good Morning America" discussing his book, Being Mortal: Medicine and What Matters in the End. It's one of the finest and most practical books I've ever read. Growing up in a funeral home, I'm probably more familiar with death than most, but Dr. Gawande's book has provided a whole new positive overlay for getting the most out of life and avoiding what's needless. It is a must read for anyone over fifty, anyone having health problems or those responsible for someone else's care.

This might seem like a heavy topic, but reading it can help us make better use of our time now, as well as preserving our health, to have as long of a quality life as possible - without doing things to cut it short unnecessarily.

No summary can do this book justice. It needs to be read in full for it to make maximum impact, nevertheless I've summarized some of the points Dr.Gawande has made below:

• Advanced age is no longer a rarity. In America, in 1790, people 65 or older constituted less that 2 percent of the population; today they are 14%. (People over ninety are, percentage-wise, the fastest growing population group. - "Sixty Minutes")
• In the past, health decline on a graph looked like falling off a cliff. Today, our treatments can stretch the descent out until it ends up looking less like a cliff and more like a hilly road down the mountain. ( A good reason to stay ahead on health exams and needed procedures to slow that decline - no matter how busy we are.)
• More than half of us develop hypertension by the age of sixty-five.
• The amount of light reaching the retina of a healthy sixty year old is one-third that of a twenty year old.
• In thirty years, there will be as many people over eighty as there are under five.
• The Threat of Falls: Each year, 350,000 Americans fall and break a hip. 40% of those end up in a nursing home and 20% are never able to walk again. The three primary risk factors for falling are poor balance, taking more than four prescription medicines, and muscle weakness. People with all three risk factors have a 100% chance of falling....Focus on what you're doing. Don't distract yourself... Being able to stand up without pushing off of the chair is a sign of well-preserved muscle strength. (See my LinkedIn post on "Falling Risks".)
• Vigilance: Attention should be paid to nutrition, medications and living situations.
• Purpose: Having a purpose, and being of service in some way, can sustain us. (It's always important to have goals, at any age, no matter how modest they are.)
• 97% of medical students take no courses in geriatrics. (It is also one of the least selected specialties.)
• Fatal Crashes: The risk of a fatal car crash with a driver who's eighty-five or older is more than three times higher than it is with a teenage driver.
• Nursing Homes: The place more than half of us will spend a year of more of our lives. The Three Plagues of nursing home existence: boredom, loneliness and helplessness. A resident said the things she missed most were: friendships, privacy, and a purpose for her days. As people get older, they dread the loss of independence. Gawande speaks in detail about how important reasonably independent living situations can be, selecting living accommodations, etc. A sage observer he quoted said, "We want autonomy for ourselves and safety for those we love." He says we need to recognize that there needs to be a balance and that people who are older or ill, will have improved lives the more independence and control they can be given in their lives and the more time they can spend doing what they care about. Innovation in care giving situations shouldn't be thwarted: "Culture strangles innovation in the crib." (That can be the case in organizations too. Innovation needs space and patience to thrive, and the willingness to allow mistakes, to achieve its potential.)
• As our horizons contract - when you see the future ahead of you as finite and uncertain - your focus shifts to the here and now, to everyday pleasures and to the people closest to you.
• The Battle of Being Mortal: The battle to maintain the integrity of one's life - to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were, or who you want to be.
• 15% of lung cancers occur in non-smokers.
• These days, swift catastrophic illness is the exception. For most people, death comes only after long medical struggle with an ultimately unstoppable condition or just the accumulating debilities of very old age.
• Is There Anything Else You Can Do?: Gawande says that patient families offer ask their physicians, "Doctor, is there anything else you can do?" He says with modern medicine, there is always something else they could do. The more important question is: Should they? We pay doctors to give chemotherapy and to do surgery, but not to take the time to sort out when it is unwise to do so.
• Prediction of Time Remaining: This struck me as just the opposite of what I thought, but Dr. Gawande said that 63% of doctors overestimated their patients' survival time. Just 17% underestimated it. The average estimate was 530% too high. And the better the doctors knew their patients, the more likely they were to err. (A very important factor for those trying to gauge the amount of time they have to arrange their final affairs.)
• End-Of-Life Discussions: Use of hospice care has been growing steadily. By 2010, 45 percent of Americans died in hospice. People who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace, and in control of their situation, and to spare their family anguish. Those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives - and they lived 25 percent longer...The lesson seems almost Zen: you live longer only when you stop trying to live longer.