A Word In Edgewise: Only Things Certain Are Death and Taxes



Today, with a good lawyer, taxes have become moot, leaving, “the only thing certain is death,” a topic movingly discussed in Atul Gawande’s highly readable book, Being Mortal: Medicine and What Matters in the End. Not exactly a holiday topic, perhaps, but one needed to be considered by family members of all ages.

Dr. Gawande knows whereof he writes. A surgeon at Boston’s Brigham and Women’s Hospital and the Dana-Farber Cancer Institute and the son of two doctors, it was not until well into his own career that he realized how medicine has failed its clientele, and how, now, it can make reparations.

The purpose of his medical schooling concentrated on “how to save lives, not how to tend to their demise.”
Here, through poignant examples (including the decline of his own, vigorous father), Gawande began to think about his patients and the inevitable end-game slide and how to be as supportive as possible during their inevitable end-game descent. Aiming for patients to be in control of their time, he wants to guide them, “insofar as possible, to keep shaping the story of their life in the world.” To discover a given story, says Gawande, tackle the “hard conversations.” Don’t tell, don’t ask, take time to discuss and discover:

What are your biggest fears and concerns?
What goals are most important to you?
What trade-offs are you willing to make to gain them?
What trade-offs are you not willing to make?

Gawande reported that goals can be as simple as “watching football on television and eating chocolate ice cream,” but this knowledge can guide the choice of treatment offering the best outcome for that goal. These conversations will assist the living as well, when one faces an anguishing choice and realizes the answer has already been made.

Death will come to all, and Gawande urges seeking not a good death, but a good life to the end. “Hope is not a plan,” he reminds the reader, and urges us all to consider, “what do you want now?” To this end, he has created a method to help loved ones, and, for the not-faint-at-heart, to begin to question ourselves about what will be the most autonomous way to bow out when it is finally time to go.

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