On the recommendation of a podcast, I just finished reading “Being Mortal: Medicine and What Matters in the End” by Atul Gawande. It’s a book full of sad stories about aging, frailty, health and dying in the US. The stories about physicians extending life, at whatever cost and for however briefly, while not considering the patient’s quality of life were no surprise to me. They mirrored what my wife went through during the last 8 months of her life following her lung cancer diagnosis. If anything, they reinforced my decision that I will end my life before putting myself through something similar. There will be no chemotherapy, no experimental treatments and no spending the last months of my life in hospitals, getting blood tests, being scanned, and going through the ordeal of dealing with hospitals, insurance and appointments that do nothing but fill my final days with aggravation. F**k that.
The other stories were about older people gradually losing their ability to care for themselves and live independently. Gawande wrote about the limited number of geriatricians, the inability/unwillingness/discomfort most physicians have when treating elderly patients. He wrote about why long term care facilities and nursing homes are missing the point – by focusing on “safety” rather than life satisfaction for the patients – ultimately sapping all joy for life from the residents.
Everyone says, “I’ll never go into a nursing home”. Even I do.
And then, someone breaks a hip, can no longer drive, forgets where they are going, loses eyesight or hearing and suffers from other limitations caused by aging or disease. If they don’t have a spouse or children who will care for them (or when those caretakers burn out), eventually they need help to live.
And in they go.
I’ll shoot myself in the head first.
I understand why other people won’t do this. Some people won’t for religious reasons. Others are afraid. Many people cling to life until the bitter end.
I won’t argue that my way is better – it’s just better for me.
Gawande did write that many physicians do not tell their patients the low probability of treatments being successful or that, even if they are, they might only prolong the patient’s life by a few weeks. He said that many doctors overestimate how long a patient will live. He said that doctors are fixers – they see a problem and they want to fix it.
To a surgeon, an elderly patient isn’t an entire human being to deal with. Instead they see a broken hip they can reset with pins or a cancerous tumor they can cut out.
An oncologist doesn’t acknowledge failure until they have exhausted every effort to zap the cancer with chemo and radiation and finally “trial drugs”, seemingly without noticing their patient is withering away before their eyes as they are slowly poisoned to death.
The only medical professionals in the book who seem to see the entire person are the palliative care professionals, the hospice doctors and nurses and the gerontologists. That was definitely my experience. My hospice case worker, nurses, aides and doctors were like a team of angels (even though I don’t believe),