Amanda Gates
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A Musings - February 2016

In recent years, I’ve thought about what I would do if I came into a lot (a lot!) of money. And I want to open an assisted living home-nursing home-hospice facility-animal rescue. All located on a big piece of land so we can have chickens and horses and dogs and gardens and beautiful grounds for our residents to live out their final days.

This dream comes from my own experience with a parent’s death, but also from bits and pieces I’ve read about end of life.

Being Mortal hit me right in the heart. Atul Gawande’s “Letting Go” in the New Yorker (and also Chapter 7 in this book) was my guiding light when it came to hospice care, and just how beneficial it is as an end-of-life decision for the one who is dying, but also how much stress it can save those who are left behind. The fact that I came across that article at just the right time still feels like a miracle to me.

I knew Being Mortal was a book that expanded on Letting Go and I’ve wanted to read it for nearly 5 years – I’m not sure why I waited so long. Because really, I wish I would’ve read this book in the summer of 2010, before my mom had a heart attack and had to go into a care facility for several weeks.

This book covers a few very important issues:

Elder Care: Geriatrics as a profession is decreasing fast, just as our population of elderly people is increasing exponentially. There’s no money in it (I mean it’s still more money than we’ll ever make, but compared to what other doctors make, it’s less). Gawande talks about how good geriatric doctors don’t focus on FIXING the problems from which older people suffer, but focus instead on MANAGING the problems. Simple things like asking them about their days, adjusting their meds if they feel dizzy (which leads to falls) or just looking at their feet and cutting their freakin’ toenails. Those things can make life better. Data shows that people who regularly visit their geriatric doctor live on their own for longer and need less medical intervention/hospitalization.

But the medical industry as a whole thinks it’s too expensive so they’re cutting/decreasing these programs at medical schools (like at the U of M).


Quality of Life: One of his huge points in the book is that when people become old, what keeps them going is Purpose and Independence. That’s why people in nursing homes that are forced into wheelchairs (you might fall!) or to remain bed-bound deteriorate so much faster. Of course all these measures are CYA for nursing homes, but Gawande visited a number of facilities around the country to find just who was doing it BETTER.

One place fought the state to let them have birds in every room, along with two dogs and two cats. Employees were encouraged to bring their children to an on-site daycare. The fact that these residents now had animals to take care of on their own, and children to visit in a daycare? Medical intervention when DOWN by double-digit percentages. One man who never talked or left his bed? Came out one day and said, “Hey, I’ll walk the dog today.” Three months later – HE LEFT AND WENT HOME. (This place was the beginning of The Green House Project. Look it up.)

Other facilities do everything they can to NOT take away someone’s independence and privacy. Rooms/apartments have locks. Kitchens are open to everyone 24-7. You want to eat cakes and cookies? By all means, go ahead, you’re an adult! They don’t force people into wheelchairs… instead they let them walk as long as they possibly can and manage falls as they come.

End of Life Discussions: Oh, Sarah Palin and every other idiot who calls these “death panels,” you suck. One of the greatest gifts given to us was when my mom’s doctor sat us all down in her room and talked honestly about the trends he was seeing in her care (“You’re back in the hospital every three weeks. Let’s talk about why that is. And how we want to proceed.”). He was open and honest and took the time to answer all of our questions and her questions. He didn’t push more intervention or hospice; he just talked about how her body would react to all the different scenarios. And what did she think would be a more peaceful way to live out her final days. (Hospice was the answer.)

Gawande, a doctor who has found himself in these discussions with his own patients, talks about just how hard it is for doctors to do this. People don’t want to die. Of course they don’t. So doctors feel a responsibility to do everything they can to prevent it. But people also don’t want to live in pain, or not be able to eat, or be bedridden or stuck in the hospital. He talks about how certain questions, like “What things must you be able to do to have a quality life?” can help doctors know just how much to intervene or when to just manage the pain.

The way he writes openly about the mistakes he’s made as a doctor, but also how’s he grown when it comes to these discussions is so enlightening. And you just hope you (or your parents) get a doctor like him when the time comes.

After an atrocious nursing home experience with my mom – and then a really good one – I felt like I pretty much knew what to look for when it comes up again. I know how important these conversations are to have with my dad and my in-laws and our kids. The more you talk about it, the “easier” it will be.

I feel now, after reading this book, I know even better what’s best. 

Posted: Thu, 02/11/2016 - 11:22 |