BEING MORTAL

Tonight, I watched a Frontline special on PBS called "Being Mortal." The program was based on the book by the same name written by the Indian-American surgeon and writer Atul Gawande. In that book, Dr. Gawande discusses the challenges of facing death and coming to terms with one's own mortality.

The issues of death and dying may seem foreign to you, but I think about these issues everyday. I think about dying when I see my patients or field phone calls/emails about them. However, I also think about my own mortality and how I want the rest of my life to be. Oftentimes, I am left with more questions than answers after encounters with dying patients or when I contemplate my own mortality.

However, Gawande distills the essence of coming to terms with dying in a series of critically important questions. To quote him: "(1) What is one's understanding of one's health or condition? (2) What are one's goals if one's health worsens? (3) What are one's fears? and (4) What are the trade-offs one is willing to make and not willing to make?" Decision-making at the end of life becomes a lot more manageable when thought of in this way.

I do not mean to suggest that these four questions make the process of dying any easier. However, the answers to these questions are immensely helpful in deciding the path that one wishes to take with the limited time that one may have left. 

No two patients will answer these four questions the same way. That is what makes us unique and special. However, it is our job as health care providers and patients alike to pose these questions and attempt to answer them. For if we do, we will identify the path that makes the most sense for us.

My answers to questions 2-3 are: 2) To spend as much time with my family and to be kind, patient, and thankful during that time. 3) I do not fear pain or suffering. I fear leaving my kids behind and not being there for them when they need me down the road. I fear missing out on the great things they will accomplish and seeing the people whom they will grow up to be. 4) I would be willing to trade side effects of treatment in the short-run if these treatments alleviated my suffering and helped me have more time with my children. I would not be willing to die in an ICU and be put on life support if I had an irreversible medical event in the setting of a terminal illness.

Answering these questions made me think of the scores of cancer patients whom I have taken care of in the hospital. Oftentimes, these patients have rapid progression of recalcitrant cancers- cancers that have ravaged their bodies and made life at home without medical care nearly impossible. These are the "hopeless" cases in whom further treatments are much more likely to be harmful than helpful. Yet, these patients' dying wish is to keep fighting, to try something else. They are willing to make every trade-off because every breath on this earth matters to them, because every minute with their loved ones matters to them. Death is not part of life for them; rather death is the end of life for them. 

I have a greater appreciation- a greater empathy- for their point of view after considering Dr. Gawande's questions tonight. Who am I to judge another person's dying wish?

Answering these questions tonight also made me re-think how I am living my life now as a youngish, healthy person. What do I hope to achieve with the time I have left? How will I make a difference? How do I want to be remembered? How should I behave and treat others? These questions are heavy, but it is imperative that one answer them. This is because the minute we are born, we start to die. However, finding a way to live our lives so that we may die with minimal regrets and maximal peace in our hearts should surely be our goal. 

Indeed,  that sort of life is only truly possible if we acknowledge that we are mortal.