Tuesday, April 21, 2015

What We’re Reading Now: Why Can’t We Talk About Dying?

Atul Gawande describes himself as both a surgeon and a writer.  Doctors train to fix their patients and the patients expect that; but inevitably the situation is unfixable.  When death is the likely outcome, doctors need to engage in a dialogue about the end with their patients.  The doctor needs to ask the hard questions: What are your fears? What is the most important thing for you in the time you have left? This means the doctor has to listen to their answers rather than just talk to the patient- it’s never easy for either party-and no single conversation can do the job.
People with serious illness have priorities beyond simply prolonging their lives…avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others and achieving a sense that their life is complete.
Gawande saw in his own practice how hard it was to have these conversations, but he wanted to do better for his patients going forward.  He interviewed palliative care specialists and oncologists for suggestions on what to say and how to listen; he related cases of his own and his experiences as a son and doctor when his father faced a terminal cancer diagnosis.  He asked his father those tough questions; his father’s responses were not what he was expecting, but they worked together to achieve most of his father’s goals in his remaining time.  
We all want a good death, but as a society we don’t talk about dying or prepare for it; the primary focus has been on living longer, even when living longer may impair the quality of that remaining life. Gawande would like us to talk about it, make it a topic of discussion with our children, our caregivers, our doctors-don’t wait until the quality of life is already gone.  Death is inevitable, but we have choices about our approach to it. Doctors and patients need to work together for a better end to life, even if that life is cut short.
The Frontline documentary “Being mortal” based on his book can be viewed on pbs.org. It’s well worth a viewing. 

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