Being mortal – Atul Gawande

Just finished reading ‘Being Mortal’.  I guess in your 50s ‘being mortal’ seems to have some more immediate relevance than in your 20s!  Atul Gawande’s book is an excellent, thought provoking read.

Only learn through experience

Much of the book focuses on the options available as people get older or as their health deteriorates.  And for all of us it is difficult to anticipate how we may feel about these developments until we experience them on a personal level – most often firstly in context of relatives and friends and then, more directly, in person.

Gawande is a medic and a prolific writer.  And this is not the first of his books I have read.  He is keenly aware, as a doctor, of the approach taken by medics: analyse the symtoms and look to implement a fix.  But he shares his concerns about where this approach leads in the case of very ill or very old people.  He is not promoting euthanasia.  And he writes from a very personal perspective – patients he has looked after and his own father’s illness, treatments and death.

Quality of mortal life = independence?

Being Mortal asks questions about later life – how we all seek to maintain quality of life and how this requires the ability to think and act independently.  Right now as I write this I am contemplating whether I will watch a football match, watch the Open golf championship, go for a walk, go to the cinema, what I will cook for dinner, etc.  and all of these options are available to me (and I take this for granted).  But if illness means that I am dependent on others then I lose much of this independence and quality of life.  And in this context re reviews options around assisted living and nursing homes.  His comparison of living at home (supported by family), assisted living and nursing home living provides lots of food for thought.  And at this stage in my life I would have little appetite for the third option.  But statistically this seems where we are all headed.  So Being Mortal is suggesting we have not yet got this right.
The examples Gawande includes around complex, expensive, intrusive, limited benefit treatments provided to patients in the throes of advanced illnesses are challenging – for medics, family relatives of ill persons and the persons themselves – not to mind the insurers and health providers.  We are well familiar with the analyses of grater life expectancy, older populations, more instances of chronic illnesses, more options for treatment of same.  But they need to be understood in context of quality of life and independence.

I learned a lot about palliative care and its role through reading the detail of some of the examples in the book.  And its a much more broader science and engagement than I had appreciated.  I am not sure how well it is really understood.

All in all an excellent book – and good material for anyone.


GAA backdoor alive and well

Watched two ‘backdoor’ games this afternoon.  Tipperary hurlers were very relived to run out tow point winners over Clare.  Both are fine hurling teams – although netiher playing particularly well today.  But we got a great contest with Clare coming back from several points behind, only to have Tipp score a couple of points to close out the game in the last three or four minutes.  After that watched a thriller football match between Mayo and Cork.  Cork have been poor until today.  They same back strongly in the second half of today’s game against Mao – forcing the match into extra time (after scoring two goals to close the deficit). Extra time was very close – and probably Mayo’s experience saw them through by one point.

So, because of the backdoor, these teams had an extended season and improved by having additional competitive games.  And I believe Tipp will be strong competition for anyone in a semifinal while Mayo have again availed of the backdoor route to prepare them for what should be an excellemnt quarterfinal against the winners of Rocommon and Kerry.