This is the title of a wonderful book by Atul Gawande that I have been listening to (I love audiobooks, listen while you do other things).
Wow, I just pasted a link and Amazon did all the rest! Anyway…
The book is about medical and custodial care of the elderly and dying. I know, not everyone’s favorite subject but as many of us get to a certain age where the years ahead are fewer than the years behind, it definitely needs conversation and thought. That darn death rate continues to hover right at 100% and never wants to budge.
Medicine has done a lot to cure disease, fix injuries, and alleviate suffering. But, medicine is all about fixing the problem and when the problem is terminal and life ending, there is no fixing that. We need to look at that care from other angles, to enhance the quality of the last stages of life for the patient and the family.
Yes, “death is the enemy,” he writes. “But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee… someone who knows how to fight for territory that can be won and how to surrender it when it can’t.” In his compassionate, learned way, Gawande shows all of us—doctors included—how mortality must be faced, with both heart and mind.
I’m a nurse. I’ve worked in hospitals, and then in home health where the majority of my work was with seniors. I’ve moonlighted in nursing homes and seen many in assisted living. More recently when I was in home health and there was more awareness, part of my job was to have the conversation. If we find you on the floor in big trouble do you want us to do everything, or nothing, or something in between? Have you talked with your family about this? If you couldn’t speak for yourself, who would you want to make decisions? What is important to you? What makes you happy to be living this life? How can we help you? Your family?
I have seen many cases of aggressive treatment to the very end. One reason I left the hospital, and nursing altogether for a while, I never want to see a code blue ever again. It’s traumatic, dehumanizing, and rarely has a good outcome. I threatened for years to tattoo DNR (do not resuscitate) on my chest. I lectured my kids when they were barely old enough to understand because of things I saw in the hospital.
I may be shortening my life by living in Panama. Maybe I won’t have access to the latest and greatest medicine has to offer (like I could afford it in the US anyway.) But, maybe I will have a longer life here, less stress, better food, clean air, good community ties, and a happy mind. We all want to make our own decisions, to live how we want to live. As a nurse I saw people do things contrary to their health and best interests, but that is their right. Do we keep people safe at the expense of allowing them to live their own lives? Do we take away so much of what makes life worth living? Thankfully there are innovative and caring people who are asking these questions and working hard to find better answers.
Anyway, read the book, have the conversations. As Jim Morrison said in Roadhouse Blues, the future is uncertain and the end is always near. But knowing that makes every day sweeter.