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Despite advances in the fields of medicine and technology, death and aging continue to be inevitable for all human beings. And the way we deal with old age must also evolve. Atul Gawande explores his view of aging in his book Being Mortal and leads the reader to reflect on how we view this phase of life. In it, Atul suggests more efficient ways to treat the terminally ill and the elderly living in nursing homes. This microbook presents modern experiences about human mortality and its weaknesses, exploring the limits of the human being.
The goal of modern medicine is to preserve human life at any cost. It does not necessarily concern itself with the quality of life, and this is a problem. Making a person's life better does not always mean healing their medical illnesses. Sometimes this means avoiding less invasive pain or care that allows the patient to come to an end more comfortably.
When nothing else can be done to save a person's life, it is time to help her accept what will come next. Fighting to the end and taking every chance to continue living is something instinctive for all of us. But many of these options will not produce results and will only make the fight more difficult than it should be. If the end is near, it may be time to rethink the individual's hospitalization.
Hospice is a service that is available with treatment, although many patients decide to waive this therapy to enjoy their last days in comfort. Hospice reduces pain and suffering, relieves stress, and can often help patients to live longer. Many patients feel that accepting hospitalization is accepting defeat, but in reality, it means taking better advantage of their remaining time.
Palliative care specialists help the patient with the pain and live the remaining time with higher life quality. But doctors need to be aware and need to be able to address this issue with patients and be realistic about the expectations of treatment.
It can be difficult to determine what should be controlled or not. The instinct of modern physicians is to deal with medical problems seeking to lengthen a person's life, regardless of how that person lives with the results. Often, treatment for a fatal disease like cancer leaves the patient very ill and only offers a minimal chance of prolonging life.
This means that the rest of the patient's life will be in suffering and pain. Doctors should ask them, "Do you want to live for a relatively short period or do you want to prolong life in a state of misery and pain?" The patient should receive all the information and be aware of the consequences of each decision before Of choose.
The patient should understand his prognosis, what his concerns are, what he is willing to do to live, and who will make his decisions if he can no longer decide for himself. Doctors should learn how to ask terminally ill patients these problematic issues and encourage them to find out what matters most to them.
It is essential for patients to understand the reality of their situation and to be able to decide what they want to happen. They need to decide on important issues like resuscitation authorization, respiratory aids, potent medications, and tubes or intravenous feeding. With all this clear and communicated, they can focus on making the most of their last days. If all of these points are considered then the people responsible for the desires of the patients will know what to do in any situation.
In the old days, people lived healthier until the time of death. They could be struck by an illness or an accident, but until they died, they lived healthily. But the modern world has changed a lot and people today have a much longer life expectancy. With this, we learn that our bodies grow older and deplete over time.
Instead of facing unhygienic conditions and suffering from infections, people began to live long enough to develop other chronic problems. These include fatal cancer, chronic diseases, organ failure and many other conditions. But modern medicine has managed to find ways to deal with many of these deadly conditions, making them mere inconveniences that can be treated until the body finally gives up.
But as diseases attack the patient's body, his condition usually deteriorates. The quality of life of these individuals diminishes gradually. Despite surgical procedures, medications, facilities and advanced technology, death cannot be avoided for long.
Instead of living healthily until the time of death, people spend a lot of time slowly deteriorating. Of course, many medical procedures can offer patients a new chance and a proper perspective, allowing them to live longer and healthier and more productive, which might not have been possible without these treatments. But some things cannot be fixed, like an advanced age for example.
Joints, teething, blood vessels, muscles, and organs fail with age, and although they may be temporarily patched to prolong life, nothing lasts forever. The inevitable truth is that we all slow down and age, though no one likes to think about it. But with proper care from a geriatrician or assistance from other professionals, many older people can remain independent and live comfortably to the end.
One of the most significant challenges an elderly patient faces is the loss of independence. As we become adults, we take advantage of the ability to make decisions and become responsible for our lives. And the more we are in control of these things, the less we realize how much of a privilege it is.
But there comes a time in our lives when independence is no longer an option. Age brings with it numerous side effects that make the locomotion almost impossible. We become fragile and old age can cause memory loss, broken bones, poor balance, poor vision, weakness, among other things. When many of these problems accumulate, individuals can no longer take care of themselves.
People today are independent and proud of it. And that's why losing that independence when we get older causes frustration, sadness, and even depression. These people were already responsible for themselves and were in control of their dignity, but old age prevented them from maintaining this. Doctors consider a person incapable of physical independence if she cannot perform these eight activities without assistance: getting out of bed, going to the bathroom, taking a shower, getting dressed, eating, walking, and getting up from a chair.
Therefore, to be considered fit to live alone, she must also be able to perform these eight activities independently: housekeeping, food preparation, shopping, washing clothes, making phone calls, traveling, personal finances, and taking medications. There are some solutions for those who can not live alone. In the old days, the family took care of these people, but nowadays this is not always possible or desirable. So they end up living in nursing homes, hospitals and facilities that take full control of their lives.
What most seniors fear is not death, but rather a frightening state of complete dependence. Old age can be described as a process of progressive loss. Whether it is losing your loved ones to illness and death or losing your mental capabilities, old age slowly steals the important things in life.
When it comes time for these individuals to seek care because they are no longer independent, most of them end up in nursing homes. While these facilities were created to help seniors maintain a healthy standard of living, they look more like institutions that do away with one's ability to control one's life.
Rest homes came from the idea that the elderly needed constant medical care and this was not successfully provided in hospitals. They created such facilities to house and treat the elderly and infirm that have become a burden to society. It was a solution that did not consider the happiness or the feelings of those who lived there.
Old people lose their whole lives when they need to move. They often need to sell their goods or store them because there is not much space available. And in many places, it is not allowed to take pets. It is challenging to consider a place in your home - and when they do not feel at home, they can't feel comfortable.
This change in their lives causes many older people to become depressed. They can lose weight, need more medications, and age even faster than before. Your physical health can be treated, but emotional and mental health does not. They feel trapped in an institution; not living in a house but an asylum. They lose their purpose in life and are simply waiting for death.
Many older people in this situation still question a few things. They argue with employees, try to fight things they do not want to do and do everything they can to keep some control over their lives and independence. This creates a constant war between employees and residents because employees are focused on doing their jobs without caring about residents' feelings.
Because of this lack of control and lack of consideration for their feelings, many seniors prefer to avoid nursing homes. When they get to a point where they need daily assistance, they look for their families. But in some cases, the work is very demanding for a modern person who has other responsibilities.
The best alternative for senior facilities is to provide necessary care and assistance while also allowing residents to maintain some control over their own lives.
Older people desire privacy when they can, discretion over their meals and personal habits and the ability to make simple choices. What they want is a home, and the purpose of a home is for the person to feel that he is in charge.
Seniors may need daily assistance, but they are still adults who want to be treated as such. They want their feelings considered, and their desires heard. What these homes should seek to do is to assist these residents to live a happy and fulfilled life. It is not enough to prolong the physical life. We also need to care about the quality of this life and how it affects a person emotionally.
Some people worry about this distinction and strive to prove that it is possible to care for a person both emotionally and physically. Doctor Bill Thomas took drastic steps to do this at the Chase Memorial Nursing Home.
When he started working in this house, he saw nothing but sadness, defeat, and despair. After some observations, he realized that this had nothing to do with medicines or medical care. What was lacking in that place was life, energy, and spirit. What he needed to provide were care and not treatment. He realized that his residents required some independence.
He identified the "three plagues": helplessness, boredom, and loneliness. We then placed plants in all rooms, made a garden for residents to care for and took pets to the site. He also allowed employees to take their children to play. It was difficult to organize this all at the beginning, and it took a lot of effort and hard work to integrate everything.
Over time, they turned the Chase Memorial Home into a place that looked more like a home. The residents took care of the animals and the vegetation, which gave a purpose and a reason to live every day. They interacted with the kids and with the staff on a more personal level. The need for medication has declined, and residents' moods have improved as well as overall quality of life. This was an unconventional method, but it did show that someone cared.
A man who had lost his will to live again cared for and had a purpose after starting to care for dogs and parakeets. And this was not an isolated case. These people felt good because they were important. We all want to feel as if we are part of something and that feeling does not change with age.
While many places overlook this need, there are a growing number of places that have changed for the better. Not all of them use the same methods to give residents food for the soul, but they still manage to give purpose and independence to the lives of the elderly.
Most people spend the end of their lives battling illness, receiving treatment after treatment to prolong their lives and temporarily prevent death. But the fact is that we all die. So the difference lies in how we spend the rest of our lives doing what is most important to us for as long as possible or fighting a futile struggle that does not let us have time for the things we love.
Doctors need to learn how to ask their patients the right questions, be realistic about the efficiency of treatments, and help patients determine how they want to spend the rest of their lives. Most people want to remain independent as long as possible and spend time with people they love. Whether it is a terminal patient or an elderly patient, the goals are the same.
The elderly do not want to be controlled and lose their independence. Although they can not prevent living conditions from changing, they can still gain quality of life if the people who care for them care.
The goal is to give people the information they need to make decisions that will give them a better quality of life according to what matters most to them.
If you liked this microbook, how about seeing the author talking about the same topic in a TED Talk? Check it out here!
Atul Gawande is an American physician and journalist. He specializes in reducing errors, increasing safety and improving the efficiency of surgical procedures. He serves as the general surgeon and endocrine system at Brigham and Women's Hospital in Boston, Massachusetts and as associate director of the Center for Su... (Read more)
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