Video Length 2:08
Who Should Read It
People who want to carefully plan the final chapter of their or their loved ones' lives.
Why Should We Read It
The progress of medical knowledge and the subsequent increase in our average life expectancy make it extremely important to think about the transition from life to death.
What Will We Learn
Paradoxically, the more we learn about how people die in America, the more we come to understand exactly what it takes to live a meaningful life.
"...just how good are we Americans at living, and at dying?"
My first three clinical experiences with death came during my time in the Kisoro District of Uganda. I was a third year medical student, and had already completed half of my year-long commitment to developing a health infrastructure in a very rural part of East Africa. I still remember all three cases- a man with alcoholism and pneumonia, a woman with widespread tuberculosis, and another man with probable leptospirosis infection. All three had passed away overnight. I remember thinking that it was unfortunate that we were not in an American hospital- there was no way they would have died there. Dr. Atul Gawande's book, Being Mortal, explores and challenges those assumptions- just how good are we Americans at living, and at dying?
"The vast majority of us do not wish to die in a nursing home, and yet this is how most of us will end our days."
Dr. Gawande offers a diverse look at the myriad of ways American society has dealt with old age and aging, but one common thread remains starkly consistent: in this modern world, we are exponentially more likely to die in a hospital or health institution than we are to die at home. The vast majority of us do not wish to die in a nursing home, and yet this is how most of us will end our days. To look at how we got to this point, we must remember that nursing homes answer a significant societal question: How do we keep an elderly person safe and healthy? The answer to this question is something we desperately want for all of our loved ones. Safety and health are not necessarily what we want for ourselves.
"Therein lies the great paradox of end-of-life care in the United States: we ignore that the questions to be answered at the end of life are exactly the same as the questions at any other stage of life..."
What do we want for ourselves? Most often, we want privacy, autonomy, and the chance to be a part of something larger than ourselves. Above all, we want to determine our own destiny, from this moment until we draw our very last breath. We would sacrifice safety and health for the privilege of determining our own bedtime and dessert selection. But we insist on the primacy of safety and health for everyone else in our life. Therein lies the great paradox of end-of-life care in the United States: we ignore that the questions to be answered at the end of life are exactly the same as the questions at any other stage of life: How do we want to live? What do we want to achieve? If things didn't go our way, what would we be willing to give up, and not give up?
"...we are all authors of our own stories, and all stories must end."
Like any other part of the world, the Kisoro villager would come to the hospital for medical care. If we could not stop the march of death, the Kisoro villager thanked us and left the hospital, presumably to die in their own home and village. Very few Kisoro Ugandans actually died in the hospital, which is one reason why my three medical cases made such strong impressions on me. We can all learn from the Kisoro Ugandan, and from Dr. Gawande. It starts by remembering that we are all authors of our own stories, and all stories must end. If we cannot acknowledge that the final chapter must be written, we will find that the American medical institution is more than ready to write that chapter for us.