My parents asked me to read this book. It is on how to make wise decisions as you see the end of life approaching – or about how to help loved ones make those decisions. In the end, it is about the author’s own experience of navigating his father’s cancer and dying. (Father and son, and mother too, are all MD’s.)
You expect a book on this subject to be about spirituality, and/or about doctor-assisted suicide. But it hardly touches on either. Gawande’s larger concern is to help us all navigate the more mechanical aspects of approaching death. Some of that involves choices about nursing homes, assisted living, etc. Some of it is also about the growing field of hospice care. The crux of the book, however, is in learning to ask the right questions of the doctors, and to learn to ask the right questions of the dying.
Doctors are involved in an intensive program to extend life. Sometimes they will give you the impression that the only acceptable course of action is for you to tackle your disease by invasive and risky surgery, chemo, radiation, etc. Often the treatment is sure to make you life miserable if you survive, and not sure to give you many more years of life. Often the doctors are only trying to get you a lottery ticket for the slimmest chance to live a few more years.
Few doctors have learned to ask patients about what their real goals are, what their real fears are, what their acceptable trade-offs are, etc.
Gawande shows the great worth of having these conversations with our loved ones. Sometimes, when a parent is in the middle of surgery and things aren’t going as planned, a son or daughter has to make a decision. If we know the loved one’s priorities, what they could be happy to live without and what they could not live without , then we know what risks to tell the surgeon are worth taking.
Working as a pastor, being around plenty of dying people, I see very clearly how valuable this book is. I borrowed it from the library, but I think I will buy a couple copies to share around.
A couple of details:
- One of the differences he emphasizes between assisted-living vs. nursing homes is that you have a door you can lock. In an assisted-living apartment, you have control of your own space. Reading what Gawande says about this, I realized that I’ve heard various people talk about their door-locks, as they contemplate their options. It’s an important part of a person’s concept of their own space.
- Gawande quotes a study’s findings, that as death approaches, a person wants less and less to meet new people, and more and more to be around the people he or she already knows. This has some interesting implications for church life, especially in ageing congregations, but also conversely in younger congregations.
WhatPastorSamIsReading 