Thursday, 26 February 2015

On Mortality

Photo credit: Tim Llewellyn
'Everywhere I see the mistake of ignoring that people have priorities in their lives besides merely surviving another day. Even in severe illness or frailty, people desire connections to others and to purposes of their own choosing.'

Dr Atul Gawande's BBC Reith Lectures 2014 on 'The Future of Medicine' have been compelling to listen to.Atul Gawande is a surgeon, writer, and public health researcher. The lectures explore the many challenges and complexities of modern medicine - outlining the limits to what medicine can do, the role of healthcare professionals, and providing insights into what is needed to improve health and healthcare systems. 

Particularly gripping are the stories about some of the people that he describes as part of illuminating specific issues and concerns. The little girl who is trapped under the ice and Peg, his daughter's piano teacher who becomes terminally ill remain vividly in my mind.
Charlotte Higgins writing in The Guardian about the Reith Lectures ('Just close your eyes and listen') comments that they are perfect for their form as podcasts. 
'Why would you want to see the Reith lectures on television? The only way we can visualise the little girl trapped under the ice, her discovery, the ambulance, the CPR by the water’s edge, the theatre, the surgeon’s cut through her chest, is through the imagination.'
It is also fascinating to hear about India and the context of healthcare - how healthcare is changing, the advances that have been made and continue to be made.  
Inspired by the lecture series, I read Atul Gawande's latest book Being Mortal – Illness, Medicine and What Matters in the End.

Previously, I worked as part of the KT-EQUAL research programme - which focused on improving the quality of life of older and disabled people. KT-EQUAL's emphasis on valuing older people and their needs and wishes formed an integral part of developments. One of the recurring themes was to counter the problematising of older age and to consider ways that ageing and health can be improved. 
Both the lectures and this book explore what it means to age and what is needed in later life. Atul Gawande acknowledges advances that have been made and that 'people live longer and better than at any other time in history' but also that ageing and dying represent challenges for medicine. 
In considering conditions and treatment options, he describes the benefits of using an approach which draws from palliative care:

‘Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: 
    • What is your understanding of the situation and its potential outcomes? 
    • What are your fears and what are your hopes? 
    • What are the trade-offs you are willing to make and not willing to make? 
    • And what is the course of action that best serves this understanding? 
He emphasizes that this is about having the conversation and not about a tickbox approach to the questions. 
The lectures and the book left me with a sense of hope - hope that even in the most challenging of circumstances people can be enabled to live their lives as meaningfully as possible.


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