The impetus for the title above is the magnificent book authored by Atul Gawande, which is subtitled: Medicine and What Matters in the End.
It is a deeply moving book and, as the back jacket notes attest, one that is of crucial importance in today’s society. Admittedly I read the book last week at daybreak each morning through misty eyes at Starbucks, owing to my father’s current experiences with being in the end stages of life. On p. 251 Gawande writes: “On the phone, he spoke more slowly, with long pauses between sentences. He explained that he sometimes felt confused and was having trouble communicating … his world was closing in.” When I call to check up on him, my father speaks sparingly, often asking me to repeat myself, and then in exasperation advising that he’ll call back. He blames his challenges on the new flip phone we got him, but it is a replica of his old one and it’s obvious that his fingers now do the shuffling rather than the walking, and his hearing loss compounds the difficulties. We save extended conversations for my daily visits, during which he’s able to lip read and watch my facial expressions intently enough to converse. He relates that he feels weak, and speaking is often an effort. As usual, he is correct.
What matters in the end? I’ll save more of my father’s experiences for subsequent parts, but if you have no intent of running out (or rushing online) to buy Dr. Gawande’s masterpiece, consider reading his interview on providing dignity through end of life care. Short of that, you can watch this video trailer with Dr. Gawande on Frontline:
The issue of being mortal is drawing wider attention. Consider this three-part YouTube coverage of a performance presented by End of Life in collaboration with the Institute of Medicine’s Committee on Approaching Death, held at the Chautauqua Institution on August 22, 2013. End of Life is a public health project that presents a reading of ancient Greek plays – here, Sophocles’ Women of Trachis – as a catalyst for a town hall discussion with expert panelists and attendees about death and end of life care as it touches patients, families, and health professionals. The panelists here are Pat Bomba, M.D., FACP, Vice President and Medical Director of Geriatrics at Excellus BlueCross BlueShield; Chris Cassel, M.D., President and CEO of the National Quality Forum; Harvey Fineberg, M.D., Ph.D., President of the Institute of Medicine; and Phil Pizzo, M.D., Professor and Former Dean at Stanford University School of Medicine, and co-chair of the IOM Committee on Approaching Death. A 45-minute discussion with attendees follows, centering on their reactions to serious illness, aging, and end of life issues.