departure with dignity.
Through his patient narratives, site visits and interviews with the
stakeholders and innovators who manage nursing homes and the
new- and- improved skilled care and assisted care facilities, Atul
Gawande has produced a compilation of heart-breaking and gripping
accounts of patients approaching their “golden years.” He has his
fingers on the pulse of aging, frailty, the loss of independence and
the loss of dignity that accompanies confinement in facilities other
than their own homes, as patients approach the final chapters of their
lives. He laments the lack of interest in the specialty of Geriatrics
and dwindling numbers of geriatricians in the United States despite
burgeoning of aging population. “I never expected that among the
most meaningful experiences I’d have as a doctor — and, really, as
a human being — would come from helping others deal with what
medicine cannot do as well as what it can,” he writes. In this book, he
precisely details various patient narratives and stories including his
wife’s grandmother and his own father and offers thoughtful analyses
and insightful perspectives. As we live longer, there is concomitant
debility, senility, pain, dementia and suffering; these afflict a sizable
portion of the elderly who face the bleak reality and indignity of
hospitals and nursing homes. In the United States, elderly patients
are often subjected to overly aggressive, unrealistic yet extravagant
invasive/interventional procedures and undergo grotesquely expensive overtreatment. Patients end up frittering away their declining
years quite miserably in institutional care in mostly well-run yet
soulless nursing homes with their “regimented, anonymous routines.” “Mortality has been made a medical experience…. And the
evidence is that it is failing,” he writes.
He describes his poignant interview over breakfast with an 87
years geriatrician and his wife with keen observation. “Both made
a point of chewing slowly. She was the first to choke. It was the
omelette. Her eyes watered. She began to cough. . . “As you get older
the lordosis of your spine tips your head forward,” he said to me, “so
when you look straight ahead it’s like looking up at the ceiling for
anyone else. Try to swallow while looking up: you’ll choke once in
a while. The problem is common in the elderly. Listen.” I realized
that I could hear someone in the dining room choking on his food
every minute or so... A couple of bites later, though, he himself
was choking.”
Dr. Atul Gawande writes very lovingly about his parents, both
immigrant physicians from India. His father, Dr. Atmaram Gawande,
came to the United States in 1963 and trained as a urologist, married
Sushila, a pediatrician and the couple settled in a small University
town in Athens, Ohio, where they raised their two children, Atul and
his sister. Drs.Atmaram and Sushi Gawande thrived in their medical
practices and gave back to the communities quite generously both
in India and in the USA. Soon after his retirement, Dr. Atmaram
Gawande was diagnosed with a spinal cord tumor near the base of
the brain and des