Illness, Medicine and What Matters in the End
Atul Gawande, Profile Books, Wellcome Collection ©2014 ISBN 978-1781253846
Atul Gawande’s Being Mortal came across my path just when I needed it. I am currently independent, but I support and care for people who are not – people who have lost their independence, who have difficulties with day-to-day activities, and who are dependent on doctors and nurses to decide what is best. What can we do to improve their quality of life and prepare them to face their own mortality?
Atul Gawande has honestly and articulately examined the American context of illness, ageing and the complexity of letting go. Although ageing is not always the problem – illness, operations, accidents and reduction in quality of life have brought many people to question their own mortality. What do we do when things fall apart? Gawande explains and analyses the world of hospice and aged care facilities to which many people are confined (sometimes with, and sometimes without, consultation). He proposes solutions to the questions raised around having the courage to face the moral and ethical dilemma around death and dying. Atul Gawande’s words are both humorous and challenging and his most poignant argument is about people not having to suffer the extension of their lives ‘at all costs’ – but living their last weeks, months and years with dignity, love and respect.
“We might be better addressing our patients’ last wishes of living out the rest of their days in their own homes, surrounded by familiar things and people.”
Our current Australian ‘western’ healthcare system is geared towards the extension of life, but is this the most appropriate way to move forward? Gawande’s book provides insights into how our ‘western’ attitudes impact on the treatment of our sick and elderly patients. We might be better addressing our patients’ last wishes of living out the rest of their days in their own homes, surrounded by familiar things and people. Gawande, with subtle humour, proposes how people could be assisted to enjoy what remains of their lives, celebrating their achievements and preparing for the inevitable end.
As an ageing aged care nurse who is caring for a loved one in that person’s own residence, I am now more aware of the complexity around choices to keep someone at home or place them in a care facility. Personally I would choose to live well with aged care services even if it meant higher risk levels and less time on this earth. In making these choices for either ourselves or others we need to address the person in question with permission, sensitivity and respect, involving them where possible in the decision-making process and ensuring their social, cultural, physical and spiritual well-being in what is inevitable for us all.
BIO: Georgina Hoddle (Georgie) is a registered nurse (RN) who currently works as an Aged Care RN on a casual basis. She is very casual because of her age. Georgie studied General Nursing at St Luke’s Hospital decades ago, retrained as an RN at Royal North Shore Hospital in 2005, and graduated from Macquarie University in 2011 with a Masters in Applied Linguistics (TESOL).
In 1991, Georgie had the privilege of spending the better part of two months nursing her dying mother at home – amongst sadness, hilarity and some prayer. Twenty years later Georgie became a Christian. She then became a member of Nurses Christian Fellowship Australia (NCFA) and is now serving as NCFA Vice President.
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