In 1967
when the Beatles released the Sgt. Pepper’s Lonely Hearts Club album, I was
finishing my freshman year in high school. That historic album included the hit
song written by Beatle Paul McCartney that most of us know all the words to
sing along: When I’m Sixty-Four.
Neither
McCartney or I could imagine actually being sixty-four back in 1967. The lyrics
“will you still need me, will you still feed me when I’m sixty-four?” seemed
somewhat logical to us. I mean sixty-four was old, right? When Paul McCartney
was born, the life expectancy of a British Boy was only 63 years old.
McCartney
turned 64 in June 2006, thirty-nine years later after his song was published.
He was also only one of the two Beatles who made it to age 64. The other two,
John Lennon and George Harrison, died before they reached the age.
When
I’m Sixty-Four has become especially meaningful to me. I lost my mother when I
was a young adult; I never had the chance to witness her age beyond her late
forties. I think for that reason, I am often perplexed and surprised that I’m
going to be 64 in just a few months and I have begun to think about my own
process of aging in the coming decades.
Upon
the recommendation of one of my colleagues at the library, I began reading Atul
Gawande’s 2014 book, Being Mortal. Gawande is the author of a handful of
impressive books – his first, Complications: A Surgeon’s Notes on an Imperfect
Science, was written in 2002 when he had been a practicing surgeon for less
than a decade. I’ve always been interested in medicine and Gawande is a
wonderful writer. I read Complications soon after it was published in paperback
in 2004 and recommended it to everyone I knew. His essays are easy to read and
each includes an important lesson about the power of medicine – or the lack of
it. Gawande proves himself to be both human and humane when explaining his
experience, stories, and decisions, both right, and wrong.
Atul
Gawande is the son of immigrants from India. He was raised in the American heartland
of Ohio and was an outstanding student, admitted to and earning his
undergraduate degree from Stanford. He went on to Oxford as a Rhodes scholar
and then began medical school. He interrupted his medical education to work for
Bill Clinton’s presidential campaign and administration, finally obtaining his
MD in 1995 from Harvard. In addition, he earned another degree from Harvard,
this one a master’s from the School of Public Health. Today, Gawande lives in
Newton with his family and practices at Brigham and Women’s and the Dana-Farber
Cancer Institute and he teaches at Harvard Medical School.
Gawande
began writing for Slate (online) when he was a surgical resident and he became a staff writer for The New
Yorker in 1998. His writing deeply
influenced Barack Obama’s healthcare legislation. He followed his first book
Complications with a sequel of sorts. Better: A Surgeon’s Notes on Performance
(2007) further spread his enthusiasm for diligence, dedication, and doing the
right thing for patients. The Checklist Manifesto (2009) was another
non-fiction bestseller, especially among those who find Gawande’s books
uplifting and hopeful despite the admission that there is much to be perfected
in the world of medicine.
Being
Mortal (2014) differs somewhat from his previous books. It focuses on the
choices our medical professionals have to make for the end of life. As we age or face a terminal illness, whether
that is at age 35, 64, or 101, we have difficult decisions to make, especially
about assisted living, long-term care, nursing homes, and prolonging our lives
unnecessarily.
Gawande
discusses the trend of aging and dying in nursing homes and hospitals as
opposed to the tradition of aging and dying at home. Up until the mid-20th Century, most families
cared for their elderly members. Today,
approximately 1.4 million people are residents of nursing homes.
After
practicing medicine for nearly two decades, Atul Gawande was struck by the
notion that he had given some patients and their families less-than-honest answers
about their prognosis. After researching the role that physicians play in
unnecessarily extending life for their patients, he decided that he needed to
be courageous and speak as frankly as he could about the decisions that
families and their dying members might wish to make. Quality of life and a
death without pain or suffering seemed much more important in the end.
Gawande
appeared on a TED Talk in 2012 in which he explains much of his philosophy
about caring for the very ill and dying. He explains that as long as 75 years
ago, physicians could only hope that their treatment would help those with
serious diseases. Broken bones could be
set. Tears and rips could be sewn up. Yet, at that time, cancer was all but
untreatable.
Dr.
Gawande, of course, admits that medicine is now saving millions of lives curing
pneumonia, infectious diseases, cancer, heart disease, and a multitude of
others. Childbirth is more of a miracle than ever before. There are over 2,000
prescription drugs that transform lives. However, death and aging are
inevitable and the medical community has a much harder time communicating that
while they are so busy and successful saving lives.
Gawande
asserts that we need to be aiding the process of dying. He explores new ideas
for assisted living, for care at home, and for hospice care. He argues that
life does not have to be prolonged with sometimes devastating results. A good
life can also have a good end.
Gawande’s
book became a documentary on Frontline for PBS in 2015 (Google “Being Mortal
PBS Frontline” and you will find it free to watch online.) Another book just published in January, When
Breath Becomes Air by Paul Kalanithi, explores some of the issues that Gawande
describes. Kalanithi, a 36-year old neurosurgeon diagnosed with terminal
cancer, explores his own mortality, something we must all do in the process at
the end of our lives.
