Atul Gawande has written a fine book. Almost a text book, with references a mile long. Perhaps it should be a set text, certainly recommended reading. Abridged, it was aired on BBC radio 4 not as book at bed time or morning story but this year’s Reith lecture .
It deals with death and how we and medics have got it wrong: unprepared to let go, conditioned to be meddlesome, with at best an unquiet outcome, at worst an unhappy one.
He writes from a medic’s perspective and from a son’s in thoughtful gentle prose that he has the grace to say did not come easily. He meditates on the experience of death and the fear it generates in the dying and in those closest to.
The fear stems from the unknown factors, when, how long will the suffering or indignities last? whether the cause of death is untimely from a mortal disease or from old age, assisted suicide is not discussed, but life with dignity is. Those precious moments of lucidity that give time to say the last farewell, the last I love yous, to savour what has been most cherished.
There are ways to manage this which mostly need a good deal of communication and resource to specialist care.
For the elderly lessening the loss of autonomy, privacy, indeed maintaining any semblance f their own life is crucial. Rather than move the elderly when it is deemed safer for them to be in a home, in someone else’s home. More often this is a recipe for unhappiness for both.
Gawande writes of what is happening in The States as that is his experience . He writes of the ‘criazies’. Those willing to revolutionise the care system, the institutions that dehumanise, sanitise even with the best will in the world, who worked out the human need for purpose and introduced pets. Every patient had a bird to look after as well as resident dogs and cats. The chaos that ensued shook the whole place, it came alive. Inmates’ mobility, moods and minds improved immeasurably
I have seen at first hand the revolution of the care home in our town. The dog that pads round to be petted that lights up the faces of those previously set to ‘dull’; the absolute joy if there is a baby or children around, and as for singing! Amazing how uplifting of the spirits it is. But, the drip feed of happy snatches has to be continuous.
Good times, even moments of happiness, right to the end are crucial and worth striving for, and are different for each individual. Ascertaining what these are by simply asking the question, important.
To accept that medical science does not have all the answers is hard. Knowing when to let go is as much an art, as the letting go itself.