This is an amazing book. Dr. Gawande is a natural writer, a person who makes the hard facts easy to assimilate. And the facts are hard and unpleasant. Both modern medicine and modern life have made a good death- and a good life leading up to it- hard to achieve. The nuclear family means multigenerational living arrangements are largely a thing of the past; modern life decrees that most families have both partners in the couple have to have full time jobs, so no one has time to take care of a senior, whose needs become more as time goes by. Modern medicine has made it possible to keep a body “alive” when heart and lung function is lost. Except in the rare cases where the body is suitable for organ donation, what is the purpose of this? The ‘person’ is gone- or at least I hope they are gone and not trapped inside that hell.
Gawande proposes a few ways of dealing with the problem that’s already hitting the US: the Boomer generation is in its 60s and even 70s. America is going to be forced to find solutions to aging well. So far, when home care cannot be managed, assisted living homes that allow pets, children, smaller units so residents can feel like neighbors, plants, and allowing the residents to take risks are working out best. People in these types of homes live longer and take fewer pain killers. The animals give them a reason to get up and to walk around. Rather than being taken care of, they are being caretakers. But this type of home is rare. More common is the unit where the residents are treated like prisoners and given no autonomy. No wonder we all fear aging so much!
Besides creating acceptable places to live, Gawande stresses the need for people to be fully informed as to what their options are- which requires a shift in how doctors treat the aging and dying population. Everyone needs to ask themselves how much they are willing to give up to stay alive. One person’s answer was that as long as they could watch football on TV and eat chocolate ice cream, he would be happy. Everyone has a different idea of acceptable and they need to think about it before undergoing treatments, many of which sacrifice quality of life for a short extension of time. Doctors, patients, and families are all twitchy about having those talks. Everyone needs to read this book.
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