Saturday, August 29, 2015



Atul Gawande has written three best-selling books and is a natural writer and a wonderful storyteller. ‘Complications’,’Better’ and ‘The Checklist Manifesto’ are his earlier works. He is a practicing surgeon, he writes for the ‘New Yorker’ and is a professor at Harvard Medical School. He is a director of a non-profit organization which works towards making surgery safer globally.

Modern medicine has been undoubtedly a great boon for mankind. Childbirth, serious injuries, complicated diseases- all of these have become controllable. However with regard to ageing and death, medicine remains counter-productive. Through his in-depth research and compelling personal anecdotes, Atul Gawande has explained the suffering his own family and patients have experienced at the terminal stage of their lives.

Assisted living homes for senior citizens and nursing homes fail in alleviating senior citizens’ anxiety over death. They adopt treatments which do more harm than good. The practices they adopt accelerate their death rather than slowing down the suffering. Left with no choice, the family goes along with the doctor’s recommendation.

The author has candidly admitted to the struggles that he has to face as a practicing surgeon. He closely examines the limitations and failures of his profession in the area of geriatric care by visiting nursing homes, hospices and geriatric clinics. He calls for a change in the philosophy of health care. All of them in this profession have been wrong about what their job is. It is not ensuring health and survival. It is to enable well-being. He compellingly argues that we need to come to terms with the reality of the eventual decline of the body, accept what matters most to us and adapt our society and the medical profession to allow people to die with dignity and self-respect. Instead of focusing on dignified living during the twilight years of senior citizens, medical professionals concentrate on the disease.

The book is divided into eight chapters each one of them a gem by itself. Chapters 2 and 8 are embedded with rich stories from his own family. He searches for models of care that help weak senior citizens’ ability to live a purposeful life. He offers many suggestions in this direction. Like adopting cats and dogs and bringing in kids to create some cheer and purpose in their lives. He also suggests splitting up floors into smaller spaces which are more homelike and help to close-knit the residents.

In the last chapters, Gawande argues that patients have priorities besides just prolonging their lives. He admits that in such cases “ we do not have adequate answers. It is troubling and has caused callousness, inhumanity and extraordinary suffering.”

Gawande explores the concept of decision making in medicine arising out of consensus rather than top down. The modern doctor “must ask, tell and ask.” There has to be a dialogue with the patient and what he is seeking is to be understood. The patient’s priorities must be paramount and the doctor must help in achieving them.

Admittedly, there are no perfect answers to the problems which senior citizens face at old age and particularly when their conditions are almost in a terminal stage. The goal should be to enable them to lead a good life till the end.

The end of the book offers a discussion on euthanasia. It is a tough call. Do we commit the mistake of prolonging unbearable suffering or the mistake of shortening valued life?

Atul Gawande has provided the readers with a deeply touching book on aging and death written with remarkable insight. He is appalled that we have turned aging into a medical problem rather than treating it at a human level. Old age and death are unavoidable but certainly we can handle them with care and sensitivity. I strongly recommend this outstanding book and urge every senior citizen to read it and breathe a whole lot of fresh air.

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