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Living a good life—to the very end.

December 29, 2014

If L hadn’t suggested a walk Christmas Eve, I might have stayed on the couch reading, and with that extra time I might have finished a book in one day. But after midnight, I had to stop. So close.

Reading an entire book in a day is exceedingly rare for me. I’m a slow reader and it takes many hours to finish a typical book, regardless of the content. I know plenty of readers who devour a book in an evening, and I remain wistful about their ability.

I’m wistful about the problem of “so many books; so little time.” We considered this question before: “How many books do I have left?” The SSA is betting on 22 more years for me. Mere hundreds of books.

The book I read Christmas Eve is “Being Mortal: medicine and what matters in the end” by Atul Gawande, who is a surgeon in Boston, a professor at Harvard Medical School and Harvard School of Public Health, a staff writer at the New Yorker, and an advocate for health system innovation and the improvement of health care around the world.

That breathless (but still incomplete) paragraph was not to impress you but to convince you this is the author to read about the failure of our medical system, and our culture, to address the inevitable: our deaths.

The book is well-written and fascinating, and the issues he discusses are extremely important in our culture today. For example, we “medicalized” the end of life until few people died at home anymore, although most people expressed exactly that desire. This is slowly turning around with the help of Hospice care.

We can keep organs going far longer than one’s consciousness. “In the United States, 25 percent of all Medicare spending is for the 5 percent of patients who are in their final year of life, and most of that money goes for care in their last months that is of little apparent benefit.”

Death panels, you say? Consider this: A landmark study in 2010 randomly assigned patients with stage IV lung cancer to one of two approaches to treatment. “Half received the usual oncology care. The other half received usual oncology care plus parallel visits with a palliative care specialist.”

“These are specialists in preventing and relieving the suffering of patients, and to see one, no determination of whether they are dying or not is required. If a person has serious, complex illness, palliative specialists are happy to help.”

“The ones in the study discussed with the patients their goals and priorities for if and when their condition worsened. The result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer.”

(Pardon my quoting Dr. Gawande so much, but it’s hard to paraphrase good, concise writing.)

“In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.”

“If end-of-life discussions were an experimental drug, the FDA would approve it.”

End-of-life may mean old age or not. The book addresses care of the elderly as well as the terminally ill. In other words: the book addresses the future for all of us, save those who die a sudden untimely death.

It’s a sober topic, but it’s not necessarily a downer. Dr. Gawande sees many ways we can do better. It’s ultimately about living a good life—to the very end.

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