Tag Archives: Harvard Medical School

Being Mortal

beingmortal

Dr. Atul Gawande has written several books and articles about modern medicine. His new book Being Mortal encourages the medical community—and the rest of us—to examine the way we face the end of our lives.

He writes of his own medical training: “I learned about a lot of things in medical school, but mortality wasn’t one of them. Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives, and how it affects those around them seemed beside the point.

The way we saw it, and the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.”

He writes about a revelation he had early in his medical career: “Within a few years… I encountered patients forced to confront the realities of decline and mortality, and it did not take long to realize how unready I was to help them.”

A story about a cancer patient who chose a difficult surgery over comfort care ends with Dr. Gawande writing: “What strikes me most is not how bad his decision was but how much we all avoided talking honestly about the choice before him… The chances that he could return to anything like the life he had even a few weeks earlier were zero. But admitting this and helping him cope with it seemed beyond us. We offered no acknowledgment or comfort or guidance.

Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.”

He writes about his daughter’s piano teacher Peg and her terminal illness: “I suggested that Peg try hospice. It’d at least let her get home, I said, and might help her more than she knew.

The hospice team put a hospital bed on the first floor so she wouldn’t have to navigate the stairs, organized a plan for bathing and dressing, adjusted her pain medications until they were right. Her anxieties plummeted as the challenges came under control.”

Dr. Gawande offered this comment regarding end-of-life: “People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world. These moments are among life’s most important, for both the dying and those left behind. And the way we in medicine deny people these moments, out of obtuseness and neglect, should be cause for our unending shame.”

One online reviewer said: “This book should be required reading for all physicians.”

Another wrote: “I’ve asked my wife to read the book so that we can discuss the final chapter in our own lives and make better plans on how to preserve the things we value for as long as we can. Making these decisions will force us to answer such questions as when is it time to say “enough is enough” to medical care.”

Being Mortal by Dr. Atul Gawande brings important end of life issues and questions to the table. The fact that they are written by a leading Boston surgeon who also teaches at the Harvard School of Medicine means that these thoughts will reach the eyes and ears of many members of the U.S. and world medical community.

(For questions about hospice care in metro St. Louis, call us at Hope Hospice at 314-984-9800.)

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Hospice Survivors

One of the great misconceptions of hospice care is that it is only for those who are just days away from dying. We at Hope Hospice work to educate the St. Louis community that hospice is for all persons who have a life expectancy of 6 months or less.

But some hospice patients live beyond the 6-month time period. Upon reevaluation, a patient may be determined to be well enough to go off of hospice care. Or a patient may be recertified to allow care to continue. Hope Hospice closely follows state and federal guidelines regarding patient eligibility.

A recent article on hospice care that ran in the Washington Post points suggests reasons why some patients outlive “a legitimate prognosis of six months.” Citing an executive at the National Hospice and Palliative Care Organization and others, the article states: “A larger portion of patients today have diseases whose outcomes are harder to predict. That’s because the portion of hospice patients suffering from cancer, a disease that has a more predictable course, has shrunk.”

An article distributed by McClatchy newspapers in 2006 shares details of a Harvard Medical School study of doctors’ diagnoses of terminally ill patients: “In 4 out of 5 cases doctors’ estimates of how long a patient would live were wide of the mark by at least a third. That is, for a patient who actually died in 30 days, 80 percent of doctors predicted 20 days or less or 40 days or more.”

One reason for the increased number of hospice survivors may be the actual care provided by hospices. The McClatchy article suggests: “With the focused attention of hospice doctors, nurses, social workers and spiritual counselors, patients get their medications adjusted and take them regularly. They get painkillers adequate to assure a night’s sleep. They eat regularly, and their loved ones get some help and relief.

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A clinical director at a hospice in Pennsylvania said, “Often, just taking away the pain and enabling them to sleep through the night gives people a second wind.”

If you have questions about hospice care and the benefits of hospice care, please call Hope Hospice at 314-984-9800.