It was a cold November evening in 2010 in Montreux, famed for its jazz festival and statue of rock icon Freddie Mercury. But it was not music that had brought me to the Swiss city. I was part of a group of journalists invited to the First Global Symposium on Health Systems Research. It was the official dinner. There was delightful company and a tempting spread. As we all settled down at various tables, a surgeon began speaking. The topic — “Why Health Systems Fail” — was the sort which could launch a thousand yawns. But this time, the audience was all ears.
The man at the podium, Dr Atul Gawande, was a surgeon and a storyteller. He made his point with a masterly mix of stories, images and facts. After the talk ended, a huge crowd flanked him. But by the time, I had got to him, negotiating my way through the throng it was too late. We exchanged smiles. Gawande said he was in a rush, had a plane to catch. I missed my chance to interview the man.
In the years that followed I read a lot about Gawande and his work. He has emerged as a a star among that select breed of doctor-writers. He works at the Brigham and Women’s Hospital in Boston and writes for The New Yorker. I loved The Checklist Manifesto: How to Get Things Right, his best-seller which powerfully argues for checklists as a way to navigate complexity in healthcare matters and beyond.
Last week, I caught up with Gawande’s new book, Being Mortal: Medicine and What Matters in the End, which takes him to a whole new level.
Here is a man who is not only a surgeon-storyteller, but a philosopher speaking with a poignant, profound and contemporary voice about issues which concerns us all, no matter where we live or who we are. In nearly 300 pages, Gawande narrates many touching stories of death and life, of wisdom and wistful nostalgia like the one about his grandfather, who died at the age of 110, surrounded by family in his home in India.
Being Mortal may sound depressing. But the book is not so much about death as the art of dying. “It is not death that the very old tell me they fear. It is what happens short of death — losing their hearing, their memory, their best friends, their way of life.” Gawande writes.
Old age and death are inevitable but we refuse to acknowledge the need to discuss ageing and dying. We don’t teach ourselves how to prepare to die. The book urges us to have hard conversations about death, dying, retirement, what can go wrong as we grow older. In his trademark style, Gawande mixes solid research with taut storytelling. We are invited to sit at the bedsides of his former patients, his family and his friends and experience their final days. There are passages which bring a lump to your throat... But as you turn the final page, you are not left with a feeling of despair. You realise that growing older, retirement, assisted leaving and even preparing for death can be positive experiences
The one message which runs through many of the stories is the pitfall of medicalising mortality. Gawande is severe when he addresses the shortcomings of his own profession “The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet — and this is the painful paradox — we have decided that they should be the ones who largely define how we live in our waning days,” he writes
There are passages, which describe in poignant detail the final days of patients who were in such denial of their imminent deaths and whose families continued to ask for futile life-saving measures...
Common to all the stories is a message that we all know but do not always want to hear — death is normal. Death may be the enemy, but it is also the natural order of things.
This is a book which emits courage and hope, despite its title. Gawande introduces us to the work of a new breed of physician-philosophers. One of the most powerful chapters in the book is “Better Life” where Gawande talks about an incredible young physician named Bill Thomas who created magic through a programme called “The Eden Alternative”. Thomas came in as the new medical director of a nursing home in upstate New York. It was a good institution. The staff did many things well. But the elderly there had a problem. They were bored, lonely and felt helpless, Television, bingo and such like did not really make any change. So Thomas started thinking about what was missing in their lives. He had a farm and suddenly a brilliant idea flashed. He brought a whole menagerie — dogs, cats, a hundred parakeets — into the nursing home. Green plants were put in every room. There’s a rib-tickling passage.
“Had they figured out how to bring a hundred parakeets into a nursing home? No, they had not. When the delivery truck arrived, the birdcages hadn’t. The driver therefore released them into the beauty salon on the ground floor, shut the door, and left. The cages arrived later that day, but in flat boxes, unassembled…”
There was pandemonium. But it worked wonders. The initiative rested on the belief that people needed a reason to live and that a nursing home did not have to be depressing or sterile. The animals, the plants, changed everything. There was a magical transformation in the inmates.
Bill Thomas who wanted to remake the nursing home is one among several inspirational figures in the book. There are others including Gawande’s own father.
“We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable wellbeing. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way…” says Gawande in the epilogue.
That message is not just for doctors. It is also all of us . The art of dying is as important as the art of living.
Patralekha Chatterjee focuses on development issues in India and emerging economies. She can be reached at patralekha.chatterjee-@gmail.com
