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Being Mortal: Medicine and What Matters in the End, by Atul Gawande.


This is an important book not only for our older loved ones but for ourselves. It talks about how our bodies age, how little we can really do about it, and how to focus on quality.


The author says that as recently as 1945, most people died at home, and now only 17% do. Why are we taking all the pills and having all these procedures to slow or stop processes that are natural? Is it in order to have more years of misery, isolation, and pain?


I can't recommend this book highly enough. It gives you a lot to think about.

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"Why are we taking all the pills and having all these procedures to slow or stop processes that are natural? Is it in order to have more years of misery, isolation, and pain?"

MJ, I think that's the basic if not eternal question.   One cynical response could be that it's b/c science and medicine have evolved to create processes to prolong life, and Big Pharma can capitalize on that.    They have to keep their stockholders happy.   I AM cynical about this issue.

Another consideration would be the vested interests of the institutions that have been created and are operating, and are in the business of providing housing, care, etc. for the aged population. 
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The really sad part is that there are very few geriatricians in this country, and they're the ones who stand up for the patient instead of all the medical advancements. We have to stand up for ourselves and our loved ones instead.
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MJ, do you think that the geriatricians don't stand up for patients b/c they're medical people and feel obliged to adhere to the predominant medical theories about extending life?    Perhaps they don't want to be considered Dr. Kevorkians?     

I don't defend them; I think there are political but perhaps  more powerful religious concepts, beliefs and controlling issues that affect both the medical and nonmedical professions.

In some ways I see comparisons to the women's rights movements and campaigns, as well as other national movements to secure individual rights.
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I read that book; it is excellent. I've observed for sometime now elders and their families will do just about anything to delay death, and to benefit who? The benefactors include, as you say, pharma, "health care" providers, and the nursing homes and other facilities that house older adults who can no longer care for themselves. I am astounded by the low quality of life that many elders have and accept so they can stay alive.
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Pretty sure there is a You Tube video as well.
The most money spent on medical expenses is during the last year or so of someone's life. Most of that is "trying to cure" or "being kept alive" . Hospice is a valuable resource to keep these costs down and improve quality of life rather than focusing on quantity of life.
Oh, the why about the pills, hospitalizations and all the rest...because it is a BUSINESS and there is MONEY to be made.
Also doctors do not want to admit "failure" and a death is often perceived as a "failure" . They are taught to focus on CURE. I think increasing the education to include Hospice would be beneficial to everyone involved.
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We've had several discussions on the forum about longevity at the expense of quality of life and I've always said that for most of us it isn't as cut and dried as it seems to be because people are living longer with good quality of life too.

Hind sight might be 20/20 but even then it's not always easy to look back and pinpoint a moment when the choice of palliative care would have been the better option. My mom's decline was slow and to me almost imperceptible before things skidded out of control when she was in her 90's, when we finally removed most of the meds that I though were keeping her alive she didn't stroke out (my biggest fear was stroke without death) or die, she just kept slowly winding down for several more years. The only crisis moments I can pinpoint were when she was struck with highly treatable conditions in her 50's (heart attack and bypass surgery) and 60's (sepsis from kidney stones). Now that I'm in my 60's I can categorically say that I'm way to young to throw in the towel yet.
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I read it a little while ago. It gives a different perspective than what medical treatment follows and gives me a better sense of how to deal with what is happening right now. My mom is now in skilled nursing after falling and breaking her hip at her memory care home. She has advanced Alzheimer's and seems to them to have no idea what is going on. They told me she keeps pulling out the IV that they put in her because she is dehydrated. I told them to stop putting it in her. I know exactly what her wishes would be if she could find those wishes in her broken brain. I have them written down in her handwriting from 15 years ago. She would want to be kept comfortable and allowed to die. She will drink water every single time it is offered to her and drink a lot of it. Pudding, ice cream, mashed potatoes, pie, and soup is all she wants to eat. Tiny amounts. She can't sit up by herself, stand, or participate in any way with recovery from this. I'm putting her on hospice in 2 days. I don't want her to die. I can't imagine life without the caregiving and advocating I've been doing for 10 years, but she is miserable with no chance of surviving this. She had a good journey and has touched many lives. She's 92. I am asking that they go with what she wants right now and to not interfere. They say she doesn't understand, but I think she does.
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Sure, big pharmas and doctors push drugs and procedures but it's the PATIENTS and THEIR FAMILIES that want life prolong treatments for everything under the sun and they are the ones that can say no more.
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GardenArtist, I think you misunderstood my comment. I believe geriatricians DO stand up for their patients rather than go with the predominant medical theories. There just aren't very many doctors with that specialty.

From what I've read in this book so far, the bottom line is that we don't treat our seniors in a manner that will improve the quality of life until they're on hospice where that's the entire goal. It's a shame that they're put on a roller coaster of ups and downs and endless crises until one crisis is finally too much for the body to withstand. Back before all this medical technology came along, the first crisis often was the last crisis, and perhaps that's how it should be.

That was how it was for my dad -- cancer diagnosis and gone in six weeks -- but my poor mother is out of her head with dementia, suffers from heart failure, venous ulcers, terrible gout (induced by drinking Ensure of all things), macular degeneration, and has had pleural effusion and Covid to boot. Other than the macular degeneration, everything she suffers from has been since the pleural effusion, and now in hindsight -- SEVEN years after that illness -- I realize that her body was giving out then and perhaps we've done more than we should have. Her memory was mostly fine before the pleural effusion, and it's been a mess ever since.

If given the choice, I think I would prefer the single crisis my dad experienced rather than the prolonged miserable existence of my mother, but of course, when that first crisis occurs, would I be strong enough to refuse treatment? I don't know.
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That book introduces the hard topics to think about & discuss. Can't recommend high enough.

Prolonging life when also prolonging suffering... Continuing or withholding futile treatments.. When is enough?

There will always be those who don't agree with the author. Others who believe in life at all costs. This one sticks for me as I had the chance to see this up close, in the drawnout ugly sibling battle it was of blame, denial & grief.

The chance to slip away peacefully was highjacked by a daughter screaming at the Doctor to "DO SOMETHING!! Save my Mother!!!"

Mother was 93 or so with advanced Alz, almost non-verbal, on thickened diet, DNR status.

Fractured hip - daughter wanted surgery. Survived surgery but lost
consciousness. Then the daughter's meltdown.
The daughter panicked. Was not ready to say goodbye I guess...

To me it seemed she thought death would be a medical failure. Rather than the end of her Mother's long life - the natural end of a 15 year Alzheimer's journey + many other health conditions.

Three siblings each wanted to control the outcome of their Mother's life: to live & be restored - to die asap - the last changed her mind daily. Not one seemed to have any ability to accept what would just *be*.

I felt sorry for them.
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