Wednesday, 9 September 2015

Book Review: Being Mortal

Atul Gawande
I've heard this doctor several times, the same CBC show repeated (.mp3). I guess there is a message for me! I bought the book.

Many decry the Baby Boomer population, with its dire threats of ill health and dementia. In the meantime, there are many, like both my cousin and friend, who reported doing 30km in a day on the bicycles!

This book shows the reality of aging, and the mistakes many can make. It's well-written, and easily readable. I wish all of our GPs could read it, although the young ones we've encountered in our many trips in to visit our specialists, they seem to understand this philosophy.

Dr. Gawande writes a bit about the history of healthcare, from the poorhouses of old, where people were forced to work, and were incarcerated. This was the time before healthcare had back-up plans for those requiring nursing care. We have many more options in this day and age.

This marvellous physician insists that doctors should be listening to their patients more than lecturing them. He suggests these questions.

Questioning techniques on the part of the physician

  1. What is your understanding of your illness at this time?
  2. What are your personal, immediate goals?
  3. What are your plans?
  4. What does quality of life mean to you? (E.g., No catheter or colostomy bag.)
  5. What are your priorities?(e.g., pain control, or quality of life?)
  6. What are your fears and worries?
  7. What are we aiming for: curative or comfort measures? 
  8. Do you want a long life or to have the best days possible in the time remaining?
There are side effects with many treatments. For example, radiation can lead to weight loss, some report being unable to taste food, others facing chemotherapy are unable to have a social life.

I have always counselled my clients to ask their physician the impact or the side effects on one's life. Chemo killed my mother. Radiation gave my father a UTI and delirium. Radiation on surgical scars can lead to life-long dates with colostomy bags or catheters. I've seen my fair share of these in my volunteer work. My 95-year-old friend, who chose a feeding tube, had a terrible time at the end of her life. 
One of my clients had radiation, but it made him too sick. Next, on his treatment plan was blood  transfusions. These last for a time, but eventually they don't work any more. He decided he'd stop treatments, and enjoy each day. Eventually he passed away, having enjoyed visits from family and friends.

There is a difference between being terminal and being treatable. We can ameliorate one's pain, many types of cancer can be put on hold, but we can also destroy the body's normal functioning. As many know, my husband with prostate cancer has chosen not to have radiation treatments, since the side effects could destroy his quality of life. Can't he have surgery?, people ask, but he did and the cancer cells have spread. Prostate cancer is a slow-growing cancer. We dwell in the present. We've seen what radiation and chemotherapy does to people already weak. He is not weak and he is asymptomatic. Life is good!

In the meantime... the mostly for-profit companies who run homes for seniors (long-term care –LTC) are making profits off the illnesses of our loved ones.

Health Care REIT, Inc. is a real estate investment trust (REIT). 
The Globe and Mail

Company Shares of Health Care REIT, Inc. Rally 2.29%
Insider Trading Report The Companys hospitals and seniors housing triple-net properties are leased to operators under long-term operating leases. Its medical office ...
The company shares have rallied 7.22% in the past 52 Weeks. On January 20, 2015 The shares registered one year high of $84.88 and one year low was seen on October 2, 2014 at $62.05. 
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@Barrie Summy


pattinase (abbott) said...

This is a book I should read but probably won't. Thanks for the summary.

Rose said...

I read this book about a month ago on the recommendation of a friend. I thought it was excellent and have been recommending it to everyone I know--including my own doctor--ever since. We've been dealing with my mother's health issues for the past several months; she's been in and out of nursing homes and is currently back home. The best choice for her and my 90-year-old father (still in relatively good health) is assisted living, but my father will have none of it. It's frustrating for my brother and me, but the book made me see things in a different light and made me realize that it's important to respect his and Mom's wishes, too. It's quality of life that is most important. The book also made me think about how I wanted to spend my old age and make sure I communicate those wishes to my family before it's too late. I only hope that there are more doctors like Dr. Gawande! I'm sorry to hear about your husband, Jennifer; I wish you both continued happiness and strength.

Powell River Books said...

I know it doesn't work for everyone, but it was easier for Mom and me to have her stay in her own condo even when she became wheelchair bound and needed 24/7 care. She went from living on her own to becoming dependent literally overnight due to a clot on her spine that paralyzed her legs. We already had condo units in the same building, so I was able to care for her during the day and sleep in my own bed at night with a baby monitor. I could run upstairs as easily as sleeping in her second bedroom, but it gave me a feeling of respite each night. It was tough on my husband who stayed in Powell River most of the time and I was down in the States in Bellingham, but we agreed it was what was important at that time in our lives. Being an only child with no children of my own I do worry about my later years. I won't have a much flexibility. - Margy

troutbirder said...

Most interesting and good advice. We dealing with Mayo Clinics diagnosis of what they call MCI. Its a long road ahead as my mom's Alzheimers showed....

Red said...

I'll have to look for this book. I seem to be on a roll reading books about health lately. Oh ya, I've been reading a few books on aboriginal history.

Linda McLaughlin said...

This is a book I should read, too, now that I'm getting older. Your review made me more inclined to buy it, so thanks for that.

Sorry to hear about your husband's prostate cancer. Having seen what chemo is like, I understand his decision. Quality of life is important, too.

Crafty Green Poet said...

sounds like a very valuable book, thanks for the review

William Kendall said...

The author sounds wise.

Yamini MacLean said...

Hari Om
A valuable read and a great review! Previous two not for me... You certainly had an eclectic mix in these three!!! YAM xx

Cloudbuster said...

Atul Gawande is quite an impressive fellow. I've seen him interviewed a couple of times, and he talked about these issues with such poise and passion. This sounds like a compelling read. Thanks for the review!

Sarah Laurence said...

Sounds like very sound advice! Thanks for sharing this book.

Barrie said...

I think reading this book would make it easier to accept the healthcare decisions of my in-laws. Thank you for reviewing.

Sallie (FullTime-Life) said...

I almost bought this for my Kindle, but then decided I need it on the shelf... Gotta get it ...patronize my local bookstore for a change.