I thought I understood death

This week I read “Being Mortal” by Atul Gawande.

We all hear stuff like “Life is short”, “Live like it’s your last day” again and again. I thought I understood this, but honestly, I never really lived like it. Somehow the message never sunk in.

That’s why reading is great. When you spend many hours over a couple of days thinking about the same ideas again and again, the ideas in the book find a firm place in your mind.

tl;dr: This book is about the inconsistency between our goals at the end of our lives, and those of our family and medicine. To resolve this inconsistency and act in everyone’s best interest, we need to have the difficult conversations with our loved ones.

What is the goal of medicine? The author shows how medical institutions get too obsessed with prolonging the duration of life at the cost of all else. Since the book is primarily about aging, old age and death, he talks about how old age homes and end-of-life care overly prioritize keeping the person as safe and free of disease as possible. This sounds good until one realises that in practice, this often entails that people live the last years of their lives in great discomfort.

In the last stages of life, we generally want to live out our lives as normally as possible, continuing to spend time doing the things we enjoy and being with the people we love. Unfortunately, the conflict in goals may mean that the rest of your “short normal life” will be traded in for life in an old-age home or one filled with treatment. These measures might extend how long you live, but completely take over how you live. During the last days, what matters more?

This mismatch between goals is a societal problem. The author remarks how old-age homes were conceived not with the inhabitant’s interests in mind, but with those of the rest of society. Today, there is promise for a shift away from these unsympathetic institutions towards either better managed homes or alternatives (such as hospice or palliative care).

The actionable advice in this book is that when the time comes, have the difficult conversations with your family. Ask each other: What matters most? What quality of life are you willing to fight for? Treatment or palliative care?

In one story presented in the book, an elderly man answers this question by saying that as long as he can “eat chocolate ice-cream and watch football”, he still wants to live. Later, when he was in ICU, the surgeons asked his daughter whether to operate the man — considering that the operation would likely succeed but had a significant chance of worsening his condition.

She asked them which decision would maximise his chances to be able to eat chocolate ice-cream and watch football.

“To operate”, they said. That is what she had them do.

Reading this book has brought my awareness to the simple fact — that I will die one day. It did not help that I got my first pair of spectacles this week which served as a stark reminder that my body is deteriorating.

Of course, the inevitable fact of death is not going to dishearten me. There is nothing anyone can do about that. However, it has helped me embrace the aging process.

Yes, I have so many more years in my life expectancy that I could pretty much not care about this. But I want to. The issue that the book presents is one that arises because people are afraid of death. Not just that, we are also afraid of talking about it and acting in preparation of our own death. If we can remove the taboo here — we would have more people living their lives to the fullest, and a better understanding of what this all for.

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