The Art of Dying

In a world where the senior citizen population is on a rapid rise, Boston surgeon Atul Gawande's book Being Mortal raises many points. Our reader H. Ramakrishnan sent us his views on the book.

Introduction

Surgeon Atul Gawande's book, Being Mortal is a reflection on the success of modern healthcare juxtaposed with the inevitable reality that is ageing and death. In the book, Gawande explores if the medical profession should rethink its approach to the old and terminally ill and whether an acceptance of mortality should define the way dying patients are treated. Being Mortal is a book that has been hailed as a classic of our time, given that the number of people aged 65 and above is projected to reach 1.5 billion by 2050. It has also given rise to varied opinions. Here is one from a senior reader and veteran mediaperson H Ramakrishnan.

Being Mortal? The Art of Dying

It was ironical that my brother handed me a copy of this book, at the venue of my aunt's 100th birthday celebrations in Chennai. The cheerful centenarian had just blessed me with a long life! Atul Gawande is a medical practitioner who thinks differently. While doctors are taught to keep their patients alive as long as possible, the author wonders if they are trained to prepare them to die.

In Yaksha Prasna, there is a question, What surprises you most and the reply is, People think they are immortal and permanent though they see several deaths every day.? All of us know we are mortal beings and yet we hope to live tomorrow. Saint Thiruvalluvar says that the most precious aspect of this universe is that the one who was with us until yesterday is no more today. 

Atul has a treasure of experience in dealing with many old, terminally ill patients. The accounts of Felix Silverstone and Alice are truly eye openers. Felix was a national leader in geriatrics for five decades. However, when he had to leave his work place, he couldn't survive the change. Almost similar was the case with Alice, an elderly woman at risk of losing the life she enjoyed. I have always felt that the best tonic for longevity is to continue your routine as long as you possibly can and never allow the body's inevitable decline to come in the way. Nature has bestowed us the capacity to adapt and live on with the routine work till we breathe our last. Relocation causes untold misery to the aged. 

I asked my ailing grandfather, who was almost in his deathbed if he continued to be an atheist or, at that stage of ill health he had started believing in the Almighty. He said, ?No. Where does God come in? This is a natural chemical disintegration of the body.? He had the guts to fight it out, though terminally ill. 

According to Gawande, ?In the past few decades, medical science has rendered obsolete, centuries of experience, tradition and language about our mortality and created new difficulty for mankind: how to die.? This is interesting. Unless one knows the ?when? of death ? which would remain a mystery until it happens ? how could you ever settle on how to die? I know of several instances when patients have ?disappointed? their doctors by living much longer than the period guessed by the latter. 

I do not agree with Gawande?s argument that acceptance of mortality should be at the very centre of our treatment to the dying. On the other hand I strongly believe that it is already the pivot around which any medical treatment revolves ? not only to the old, but to patients of any age. It is the duty of the doctor to inject the hope of longevity to his patients. After all, mere existing is different from living.

And yet, Gawande has a valid point: ?Taking care of the debilitated, elderly person in our medicalized era is an overwhelming combination of the technological and the custodial. The burdens of today?s caregiver have actually increased from what they would have been a century ago.? However, his presumption that once aging led to debility, it was impossible for anyone to be happy may not be acceptable. Until very recently, in India, every home was an old-age home. The old were taken good care of by the successive generations. Thus, they didn?t miss any joy of the family life. The advent of retirement homes and old-age homes is a recent phenomenon. The (great) grandparents don?t get to play with their (great) grand children. Thus they miss a lot of love and affection. They find themselves unwanted. This is one of the many disadvantages of old-age homes. 

A former colleague of mine who lives in a retirement home in Chennai has a sad tale to narrate. The home charged him a few lakhs of rupees as non-refundable deposit. Since then the deposit amount has multiplied several times. If he moves out i.e., if he passes away- the home stands to gain enormously. And therefore the home does't care to offer him good food or other quality comforts that he was used to earlier! I cannot imagine what would happen if he falls seriously ill. I wish his children (now adults) had taken care of him!

Finally, it is all about the emotion. And, as Gawande rightly points out, at home you decide how you spend your time, how you share your space, and how you manage your possessions. Away from home, you don't. This loss of freedom was what people like Lou Sanders and Wilson?s mother, Jessie, dreaded.? 

In his epilogue, Gawande tries his best (although with partial success in my opinion) to send readers on their way with a reasonable hope that medical science has given us remarkable power to push against the limits of our biology genes, cells, flesh and bone. However he confesses that such power is finite and always will be. That is because; well-being has more to do than just with physical health. It has an emotive, sentimental element too.

Overall, the book is an important contribution that addresses an issue of high priority; it does deserve a wide readership.

About the Author

H.Ramakrishnan is a well-known media-man, having had decades of experience in News editing and reporting. He was until recently in the panel of Book reviewers in The Hindu. A voracious reader, his main interest is Philosophy. He is an Advocate, a good speaker, a musician and has received the prestigious Kalaimamani Award of the Tamil Nadu Govt.