Friday, August 28, 2015

The Cephalopod Coffeehouse: August 2015

Welcome one and all to the Cephalopod Coffeehouse, a cozy gathering of book lovers, meeting to discuss their thoughts regarding the works they enjoyed most over the previous month.  Pull up a chair, order your cappuccino and join in the fun.  If you wish to add your own review to the conversation, please sign on to the link list at the end of my post.

Title: Being Mortal: Medicine and What Matters in the End
Author: Atul Gawande
via Goodreads
Death is inevitable.  That is the one inescapable truth of human existence.  Yet the medical establishment is armed to the teeth with both the tools and the philosophy to prolong life as long as possible, too often disregarding the quality of life it fights to preserve.  Dr. Gawande, a surgeon himself, shines a light on this troubling dilemma.  He exposes the failings of his profession but also the efforts of those who work to provide a more noble, dignified and enjoyable life to both the aged and the dying.  He is not shy about discussing his own shortcomings and how learning about the alternatives has made him a better doctor.

As Gawande points out, most people in the industrialized world do not die abruptly.  Modern medicine is a lot better at fending off the Reaper than it was even a generation ago.  Also, most of us are going to require a significant level of care as we near the end.  Nearly a quarter of all Medicare expenses are paid out in the last year of life.  Yet most people don't devote enough thought to how they want to live at the end.  What makes our lives worthwhile?  What sacrifices are we willing to make in order to live more meaningfully?  At what point does letting go of life become more important than fighting death?

Gawande explores all of these questions in regards to long-term care, doctor-patient relationships, palliative care and other end-of-life choices.  He interviewed experts in pertinent industries but also shares his own experiences, both personal and professional.  The material can be difficult to read at times but that's sort of the point.  As humans, our natural tendency is to live in denial of our own mortality.  We never talk about it.  We never think about it until we must.  By then, we're too often making critical decisions based on lack of information, external influence from doctors and the pressure of the moment.  Meaningful conversations with our loved ones and professional providers are vitally important.  We should have them early, before we are forced to act in desperation.

The book's cautionary tales are brutal but Gawande does provide a hopeful path forward.  Oddly enough, it did not leave me fearing death.  For me, there has always been a comfort in knowing that life is finite.  We have no choice but to make the most of the time we have. 

So, you need to read this book.  Because if you're lucky, you'll grow old.  More importantly, regardless of whether you're lucky or not, you're going to die.  The same is true for everyone you care about.  Being Mortal provides meaningful guidance in helping one another face the inevitable.

Please join us and share your own review of your best read from the past month.  This month's link list is below.  I'll keep it open until the end of the day.  I'll post September's tomorrow.  Meetings are the last Friday of each month.  Next gathering is September 25th.


26 comments:

  1. That's a book that interests me. I worked in a nursing home and saw so many people who wanted to die and were ready to die who were kept alive by their families. It's part of our culture that we want to keep people alive as long as possible, no matter how much they suffer. My children have strict instructions to never put me in a nursing home and to never give me a feeding tube. Of course, I also have a DNR order in place. Sadly, the patient's wishes, even when they're in writing, are often disregarded. Thanks for bringing this important information to our attention.

    Love,
    Janie

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    1. Thank you for sharing your experience. These are important questions we all need to face.

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  2. I agree with Janie. This topic interests me as well. I'm thankful my parents respected their parents wishes when it came to dying, but I know a lot of people don't. It's really sad that the healthy want to keep the very sick alive and lingering in pain. While it is sad to lose someone you love and you will miss them forever, I think it's more painful to see a person suffer. I will have to add this to my list of books to read.

    Jessica

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    1. Obviously, letting go is a challenge for all parties involved. Accepting the inevitable, though, can also be liberating.

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  3. I've had these discussions with my family. When my father was dying, it was his expressed wishes that there be no ventilator--and when his lungs could no longer sustain his body we gathered around and prayed and sang him to sleep. It was a good end, the one he wanted, and though it was hard to do, letting him go, when there was not further medical care to keep him truly living, was a remarkable and blessed experience.

    Thanks for sharing this one!
    Veronica

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    1. The book includes many such endings. Your family did well.

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  4. That sounds like an interesting book, one I might actually pick up sooner rather than later.
    However, I'd have to balance it against the knowledge that we might actually be entering a time where death from natural causes ceases to exist.

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    1. To be honest, I don't think that is an appealing future. It would present a lot more problems than it would solve. I won't claim that scifi has all the answers but the obvious reference here is Star Trek TOS: "The Mark of Gideon."

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  5. Considering the right to die (not sure if that is what it is called) was passed in Canada recently I think this is something we all need to think about but few do. I would broach it with my mom about what she would want-cremation vs burial, life support vs just letting go and she would never answer the question. It would turn into a philosophical discussion-a good one but nothing was ever confirmed. One thing she did say is that she never wanted to be a burden to her children. If ever anything would happen to place her in long term care. I am glad she always said that because that is what my brother and I had to do when her dementia took hold. She would balk and say "I'm not crazy" when I would mention that she had a bunch of mini strokes causing the memory loss but that she is not crazy but it was always difficult. Remembering her words helped. Now she lives in a really nice home and she engages in some exercises both mental and physical which is good. She knows who we are and can talk but by the end of a sentence, she has already forgotten what the beginning was about. Her roommate is 104 but she is deaf and bedridden and no longer is aware of her surroundings. I am certain that if that lady, 30 years ago, knew where she would be at she would say to let her have a dignified death. The lady is not hooked up to anything but her life now if not quality at all. Of course these are tough calls but I would want to choice if i knew my life would end up like that. I would only give the order to let me go, though, once I end up in that state. My mom, even though you feel like you are doing the "Who's On First" skit, can still hug and laugh and appreciate hugs in return. She can recall the past and enjoy certain times. She still, to me, has quality. This book does sound interesting and brings up difficult things most people have a hard time facing.

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    1. I expect you would find the book quite meaningful. Regarding Canada's new law, assisted suicide is touched upon briefly but other options - hospice, for instance - are explored more fully.

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  6. Interesting book interesting subject.
    I have a will set up with about as many of these problems we could think up with hospital and long term care.
    My lawyer even set up where only one doctor needs to sign off and not the usual two that many states needs.
    It is a very complicated, sad, tiring and emotional subject.

    cheers, parsnip

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    1. It is emotional. I gave our copy to my parents. They have read it and enjoyed it but our own conversation about our family may yet prove challenging.

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  7. This is a topic that's been on my mind a lot lately. Thanks for the recommendation!

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  8. We are preparing a Living Trust. Put it off for years, but watching my parents fade rather than die is horrible. Everyone should make their wishes known in writing, notarized, and shared.

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    1. We made some provisions when we did our wills. We should probably revisit that. I don't think our personal philosophies have changed but we should make sure we have our bases covered.

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  9. As a nurse, I've seen so many instances of nearly futile efforts to prolong life -- for what? Many young people with terrible brain injuries or non-viable organs suffer terribly while the family, out of love, tries to prolong their "life." It's so sad to me.

    This sounds like a must-read book. Thanks, Squid!

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  10. This is a vexed question. I believe in the sanctity of human life, but quality of life is the question. Sounds like an informative book AS.

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  11. This sounds like the sort of book that should be required reading. And while I'm all for living forever, that's only a good thing if you're enjoying it. I'm also reminded of a conversation I need to have with my mother...Thanks for this recommendation, Squid.

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    1. My pleasure. I hope you'll check it out. Share it with your mom, too.

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  12. I hadn't heard of this one before, but it does sound like an important read. Sounds like it will be a book that will help us do some necessary thinking. Thanks for sharing. :)
    ~Jess

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    1. My pleasure. I hope you will check it out.

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  13. I certainly think understanding and accepting your mortality is important. Too many people live life as though they will never die (teenagers are especially guilty of this). I also think it's important to make some decisions about prolonging versus letting go in the cases of life support, etc. I know these are discussions my family has had. No one likes to talk about it, but it's crucial for loved ones.

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    1. It certainly is crucial and you are so right about teenagers. It's age appropriate, of course, and one would certainly never wish a rude awakening upon them. Gawande touches upon how life's focus tends to narrow as we age.

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