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Book Rec: Being Mortal
Old 12-21-2019, 01:34 PM   #1
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Book Rec: Being Mortal

This wonderful book made me reflect and rationalize my long term thinking.

https://doctorinprogress.com/2019/08...rs-in-the-end/

"...physicians often fall back to optimism, not wanting to disappoint their patient’s expectations or challenge their own competence by seemingly “giving up.” Competence gives doctors satisfaction and a sense of fulfillment, but death challenges this competence. Thus, doctors do not like to admit the ceiling of their capabilities, so they offer some more last-ditch treatment instead of what the patient really needs: comfort."

"It becomes much easier for doctors and patients alike to cling to a hope-filled fantasy about beating the overwhelming odds than to deal with the likely inevitable. There is nothing necessarily wrong with hope. There is something wrong with hope impeding clinical decision making. For instance, Gawande notes the jaw-dropping statistic that “more than 40 percent of oncologists admit to offering treatment that they believe are unlikely to work” (167-68). Furthermore, there is something wrong with not even discussing the more likely scenario and not having that hard conversation about potential end-of-life."
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Old 12-21-2019, 02:14 PM   #2
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When my late wife was diagnosed with small cell carcinoma, I did some online reading; I can't recall the exact figures, but I seem to remember an estimated possible survival rate of 5% or thereabouts.

At the onset I thought that, if anyone was strong enough to beat it, she'd be a certainty.

I was wrong, but we always based our hopes on that presumption......(at least I did....in retrospect I sometimes wondered if she was humoring me.)

If there's hope...go for it...even, (perhaps), if it's misplaced.
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Old 12-21-2019, 03:14 PM   #3
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Yes, it is a lovely, compassionate book by a physician who has walked the hard path. It helped clarify my thinking.
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Old 12-21-2019, 03:16 PM   #4
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Also read the book. It also describes, in painstaking detail, the absolute miserable existence that many in LTC endure. Chronic physical pain, acute loneliness and isolation, being herded like animals (because residents WILL march to the feeding, cleaning, exercise schedule, etc).

Add this to OP's observation (and the enormous cost incurred to play God in the final years of life), and it makes a compelling case that geriatric/end of life care is profoundly off kilter.

A good read for many here.
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Old 12-21-2019, 05:01 PM   #5
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For several years this has been the book that I have given to students that I have taught. I have read/listened to it 3 times. Definitely on my recommended reading list.
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Old 12-21-2019, 06:44 PM   #6
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Great book. In my case it validated the decision DH and I made when he was diagnosed with acute myeloid leukemia and they said chemo had a 3% chance of success. (He was 78 and weakened by chronic health issues.) He died peacefully at home with hospice care. My mother made a similar decision when faced with a recurrence of breast cancer at 85. Both avoided the misery of the side effects of treatments which had little chance of success.
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Old 12-21-2019, 07:07 PM   #7
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+1. My area is public health and health policy, and I loved the part on the history of nursing homes, but it's all great.
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Old 12-22-2019, 06:24 AM   #8
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Old 12-22-2019, 06:31 AM   #9
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Read the book a few months ago.

Borrowed it from my local library.

Good Read.
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Old 12-22-2019, 07:42 AM   #10
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"Read it" via audio digital download from the library.

My folks are both 89 and nobody lasts forever. I will be their executor when that time comes and one of the few people they talk to about "serious stuff". I found it to contain valuable insights about choices they may have to face.
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Old 12-22-2019, 08:10 AM   #11
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This book should be required reading for all adults. Regardless of which path you choose, we all have to pick one in the end. There is no absolute answer. Every circumstance is different.
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Old 12-22-2019, 10:03 AM   #12
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My DM lived alone until she was passed her 92 birthday. She paid her bills with a magnifying glass, got rides from younger friends who could drive to church and hair salon, grocery store. She had nice friends from church. She lived with us for 3 months and lasted less than 2 weeks in a nursing home. Her very wish. That picture in the article from a nursing home was spot on. She hated it there and I believe she hurried her own death by refusing to eat or drink.
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Old 12-22-2019, 10:38 AM   #13
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Good book.
I am forever grateful for the one MD, who during my DF frequent ER visits his last couple of years, was the only one who discussed hospice care. Dad was not ready at that time, but the subject was out there.
On his last ER visit, Dad told us kids he was ready to go home. We told the ER doc (who was younger) he was ready for hospice. That doc was really surprised, left the room and we never saw him again. The hospice team came in later. Dad died peacefully at home with his family there.
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Old 12-22-2019, 10:50 AM   #14
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I think often about mortality. Too often.

At 71 I'm thinking why read a depressing book? I'd rather read about how to do life better while healthy ... exercise, eating, etc.

Perhaps I should read something like this in 20 years?
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Old 12-22-2019, 02:55 PM   #15
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Quote:
Originally Posted by Lsbcal View Post
I think often about mortality. Too often.

At 71 I'm thinking why read a depressing book? I'd rather read about how to do life better while healthy ... exercise, eating, etc.

Perhaps I should read something like this in 20 years?
If you have children, you could consider recommending it to them. I frequently recommend it to 20-somethings.
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Old 12-22-2019, 03:07 PM   #16
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Quote:
Originally Posted by Lsbcal View Post
I think often about mortality. Too often.

At 71 I'm thinking why read a depressing book? I'd rather read about how to do life better while healthy ... exercise, eating, etc.
I didn't find it depressing- I found it thought-provoking. I can't remember if it was this book or a podcast on the subject but it brought up the question you have to ask: "what is life?" It makes you think about when you want to throw in the towel/pull the plug. An example was a guy who said he was good if he could eat chocolate ice cream and watch football. It led me to think about it and tell DS and DDIL that my standards were higher. If I'm mentally oblivious or if I'm likely to be bedridden if I recover from treatments, I don't want treatment. To me, what would really be depressing is being in oblivious or bedridden after a lot of expensive, risky treatment you didn't want in the first place.
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Old 12-22-2019, 05:20 PM   #17
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I read the above book a few years back, after recovering from an illness that could have ended my life. I liked it, and read the earlier books by the same author, and reported here.

I am never one to be in denial, so always want to face the truth, even in the matter of end of life.

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After reading the most recent book by Atul Gawande, a surgeon, as reported here, I requested from the library his first two books.

In his first book, Complications: A Surgeon's Notes on an Imperfect Science (2002), Gawande talks about fallability of doctors, who of course make human mistakes in their work. He next describes some anecdotal puzzling illnesses that he personally knows of. The last part of the book retells some cases he was personally involved in that had ambiguous symptoms, and doctors could easily take the wrong course of action.

In his second book, Better: A Surgeon's Notes on Performance (2007), Gawande talks about how some doctors provide better care with their diligence and ingenuity. Near the end of the book, he describes how he is impressed with Indian surgeons who manage to treat impoverished patients with so little equipment, and who are able to perform many different operations that he would not dare to tackle.

In my younger days, I would not be too interested in books like these, but after seeing our parents through old age, illness and death, and myself at the age when maladies start to sneak up on you, and indeed having been through some major operations for a life-threatening disease, I appreciate these books on medicine subjects more. Gawande has many interesting stories to tell, and he knows how to write for laymen.
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Old 12-22-2019, 05:35 PM   #18
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I first heard about (and then read) this book following a discussion about it here on er.org.

It is so much more than how to deal with terminal disease.... it's about aging and living as you age.... It has shaped my thoughts on long term care, assisted living, medical care, DNRs, and figuring out what makes me happy and is my "treat until I can't do that happy thing." (For the author's father it was tennis.)

A very good, and inspiring book. Inspired me to think long and hard about all the aspects of aging and dying.
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Old 12-22-2019, 05:36 PM   #19
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I read this book and it was excellent. I had a friend with stage 4 ovarian cancer have surgery and chemo while given 6 months to live. She lived 20 years but battled it 8 times. I think the decision is different at 50 versus 65. She loved living but suffered a lot.
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Old 12-22-2019, 06:16 PM   #20
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I might take a peak at the book just to prove I have an open mind.

But I am going to be posting here for the next couple of decades.
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