It’s January 6th. Happy New Year. Is this post late? Maybe. Regardless, I have some important thoughts about a resolution this year.
On Christmas Day (December 25th), I finished reading Atul Gawande’s book Being Mortal. Gawande is a practicing surgeon at Brigham and Women’s Hospital in Massachusetts. In Being Mortal, Gawande takes issue with the current state of end-of-life care for the aging and dying here in the United States. With all the “care” available, from nursing homes to hospices, the aging and dying experience discomfort, dehumanization and sometimes downright depression as we tend to ignore individual desires in order to “fix the problems of aging.”
As Gawande explains, the advent of modern medicine has surfaced an entirely new field of medicine: caring for the aging, elderly, and the dying. Before modern medicine, most people died when they acquired a particular disease. Even the common cold could turn fatal. So the idea of aging- of particular parts of our body beginning to malfunction or deteriorate- is indeed new. The “natural causes” we die of would not even have surfaced in most people 300 years ago. Modern medicine also warps our perception of death: when we can defy it, even for a while, death becomes the enemy. This, despite dying being the most natural thing humans do.
Being Mortal explains that the problem with end-of-life care is the dissonance between doctors’ relationships with medicine and care. Most doctors see themselves as fixers- a patient has an illness, and their job is to piece together the cure or treatment puzzle. The problem with the aging and the elderly, or further the dying, is many times there is no easy answer- treatment causes other symptoms, patients’ bodies may not be in shape to receive it, or the risks may be too great. Doctors tend to give options that weigh time vs. comfort- take this treatment to lengthen your life, but you’ll be miserable. What is important to those who have a very limited time left on earth? When asked, most said time was less important than creating significance for the last months, days, or even hours.
The most important difference between me and someone in their early 80s is perspective. In two days I turn 28. Perhaps this is selfish and prideful, but I am not ready to die. In my mind, my life is only beginning- I have so many more experiences to share and so many people to meet. To someone who has lived a bit longer, this attitude may seem quaint. At every stage of our lives, we hold certain people and certain activities dear. We prioritize. I am not sure when we reach the turning point to say “I’ve lived enough, let me die in comfort and peace”…perhaps that attitude it dictated to us when we discover our bodies have reached the end of their ability to function.
My cousin Heather passed away when she was 28. She was hardworking, sarcastic, and adored her son Austin and husband Ryan. I found out when I was training to be a campus fellow for the Interfaith Youth Core in Chicago, and flew home immediately. As much as I missed her and felt the pain my aunt, uncle, cousins and family felt, the best word to describe my overall sentiment was eerie. Her death was unnatural, it was wrong and unfair. Someone so young had so much left to do. As I turn 28, I wonder if she felt the same way I do, or if forced nearness to death brought some form of peace and acceptance of a life lived from beginning to end. Perspective dictates what we deem important at different moments.
Gawande concludes Being Mortal by suggesting five questions we must ask as we plan for the end of life, for others and ourselves. They are:
“1. What is your understanding of where you are and of your illness?
2. Your fears or worries for the future
3. Your goals and priorities
4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?
5. What would a good day look like?”
What would it look like if we asked these questions regardless of our perspective- if I, 28 years old and seemingly healthy, asked myself regularly, “what would my goals and priorities be if I really did only have a week to live?” It seems like a silly ice-breaker, but facing this seriously each day in 2016, I have already begun to recognize some hidden priorities and places where I waste time. The last question intrigues me most: what would a good day look like today? As 2016 hums along, my resolution is to wrestle with end-of-life questions, learning to understand more deeply what really matters to me and the people I love.
Gawande, Atul. Being Mortal: Medicine and What Matters in the End. New York: Metropolitan, 2014. Print.