Despite being in my twenties, I had a bartender tell me I looked thirteen years old. To take advantage of the situation, I dressed up as Piglet from Winnie the Pooh on Halloween and went trick-or-treating to see how many strangers would give me candy without question. I got over 100 candy bars (many full sized, because wisdom gained over the years dictates that rich, elderly neighborhoods are the most fruitful). The consequences of growing old, finding a nursing home, or how the meager money in my RRSP should be spent during retirement are all fleeting thoughts that carry little weight. If anything, it is weight easily shrugged from youthful shoulders. Being able to trick-or-treat successfully at twenty-three often leads to such delusion of immortality. Having full autonomy to walk around a nice neighborhood collecting candy and making unhealthy eating choices had always been taken for granted. Then, I read Being Mortal by Dr. Atul Gawande, and I began to seriously think about death and senescence.
In this book, Gawande makes the consequences of aging in our highly medicalized health care system shockingly clear through a series of reflections and anecdotes from patients and innovative physicians alike. In our current health care system, we have come to expect cures and miracles from our physicians- popping an antibiotic can eradicate previously debilitating diseases, and a poke in the arm can prevent pandemics. But what happens when patients present with an unfixable problem? While most diseases have a solution, it is inevitable that our bodies will grow weaker with age or illness and eventually, multiple physiological systems will begin to shut down simultaneously. This “accumulated crumbling of one’s bodily systems”, as Gawande notes, becomes too complex to fix with simple prescriptions. As the body’s machinery falls apart, no amalgamation of pills, ventilators, tubes, or injections can turn back time. Gawande points out that our blind trust in the power of modern medicine has made it increasingly difficult to accept our mortality. Patients facing the end of their lives have increased hopes that they can prevent the inevitable, gambling on the coin toss between hopeful recovery and risky operations that could lead to even more suffering. Unfortunately, as Gawande summarizes, it is all too common that “the waning days of our lives are given over to treatments that sap our bodies for a sliver’s chance of a benefit”.
In his narrative, Gawande paints a picture of our current healthcare system that mistakenly prioritizes the prolongment of biological ‘health’ at cost of the emotional ‘care’ that patients often seek. As I read on, I came to understand how poorly our society has prioritized our future. Our life expectancy has climbed to optimistic new heights but it only buys more time to be spent bedridden from an unrelenting illness or institutionalized in nursing homes with strict schedules and little autonomy. I had always considered the retired life to be an opportune time to be free of responsibilities, to pursue new hobbies, and to eat at Michelin star restaurants twice a month (provided I start saving money in my RRSP like my dad keeps telling me to). But with every turn of the page, worries that aging meant losing the freedom to live life by my own terms began to mount. Anecdotes about senior residents forbidden from eating M&M’s for fear of choking or being told to trash their memorabilia for fear of fire hazards show the potential negative emotional consequences when long-term care facilities and caretakers prioritize safety over satisfaction. Gawande’s account of Keren Brown Wilson, a woman who wanted to create a better nursing home for her mother, emphasized a major flaw in the current system. Wilson’s mother had just one condition for her accommodation: to be able to wake up when she wanted and to have control over her own schedule. Such a simple request is often not granted, demonstrating the loss of autonomy most residents face. Through this book, readers are sure to recognize how the privilege of independence should not be taken for granted.
Despite the flaws of some nursing homes, Gawande shows that improvements are possible with some creativity. My favorite anecdote was of Dr. Bill Thomas, who expelled the gloomy atmosphere that had settled over the senior residents of Chase Memorial Nursing Home by introducing novelty into their routine. He introduced plants, children, dogs, cats, and even one hundred parakeets into the nursing home and revitalized the care for the residents of the nursing home. He gave residents responsibility over lives other than their own and research into this nursing home showed that residents took less prescription medicine and deaths dropped by 15 percent. Gawande thus demonstrates that creating meaningful experiences in the field of geriatric and palliative care can improve health even more effectively than focusing solely on medical interventions.
Through this book, I was able to slowly add new perspectives and fresh insights into my understanding of palliative care and mortality. Gawande emphasized the failings of our society when it comes to accepting death and senescence, but he also revealed how we can learn and improve. Although I had never seriously considered retirement, this novel caused me to pause and consider how I want to spend my time in old age, and what my priorities will be. Is the priority to live long or to live well? As a society, how can our institutions offer both choices to senior residents? Gawande advocates that “whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life.” In Being Mortal, the stories intertwine to form a central theme that mortality is about the struggle to live freely despite the constraints of our time here on earth and that the role of healthcare and institutions ought to be in aiding people to not only have a healthy life, but a fulfilling life – up to the very end.