Being Mortal: Medicine and What Matters in the End

The advances we have made today in science and in medicine have immensely altered the course of our lives. Modern medicine has given humans the ability to push against the constraints of our mortality, and today we live longer than ever before. These advances have turned aging and dying into medical experiences that are to be handled by health care professionals. I believe health care professionals can become focused only on our patients health, safety and survival in their declining years.

This causes us to sometimes overlook the things that matter most to them in life and their reasoning for wanting to be alive in the first place. Being Mortal by Dr. Atul Gawande does an excellent job of explaining the dilemma doctors and nurses face when it comes to providing care for the dying patient and I could not agree with him more when he explains just how unready a lot of us are to help them.

In his book, Dr.

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Gawande explains the successes and failures of modern medicine when it comes to death and dying. Through telling us stories about his own patients and family, he shows us the suffering that can occur when medicine neglects to address the wishes and needs of people beyond just survival. Gawande explains that a simple view of medicine is it exists to fight death and disease. Death is the enemy and it has superior forces. Medical professionals are tasked with guiding our patients through this war with death and it is our responsibility to let our patients know when we feel territory can be won and when it can’t.

Instead of just offering the terminally ill every treatment available until they tell us to stop, we need to be able to have those hard discussions with patients and their families and help them prepare for what is to come.

By finding out what is important in our patients lives, their hopes, their fears, what they are willing or not willing to sacrifice for more time, we can help guide them in making decisions about their medical care and living the best life they can all the way to the very end. Dr. Gawande then shows us what can happen when we have these difficult conversations and give the patient the ability to live a life as full as possible under the circumstances. Even if it means stopping chemotherapy or surgeries and focusing on comfort and happiness, the research tells us that patients and families are happier, and often times live longer than they would have if medical treatment were continued.

As a future nurse anesthetist I feel that our profession is in an extremely important position when it comes to helping the incurably ill patient decide whether surgery is something they truly want. Also, knowing when to speak up for the patient or their family when we feel surgery could do more harm than good and potentially prolong suffering. As nurses, we are taught to look at the patient holistically. This is different than what is taught in medicine which is focusing on symptoms and providing a cure to a specific disease. I believe this gives nurse anesthetists an advantage when it comes to understanding how important a person’s well-being is to them especially toward the end of their life. Therefore, having those difficult conversations with patients and their families if the surgeon will not, is something we must have the courage to do.

As advanced practice nurses that are experts in pain management, nurse anesthetists also play a role in providing chronic pain relief to many terminally ill patients nearing the end of life. Knowing what specific questions to ask patients in order to determine what intervention or prescriptions are needed to minimize pain and maximize quality of life as much as possible is extremely important and nurse anesthetists are uniquely skilled to deliver pain management in a compassionate and holistic manner. By providing patients with unrelenting pain, relief we can play a huge role in giving the patient the ability to enjoy the moments they have with family and friends and help them maintain some functionality. As Dr. Gawande tells us in his book, these are some of the things that truly matter to people that are nearing the end of their life.

Overall Being Mortal is an excellent book and one that medical professionals should certainly take the time to read. It reinstates the importance of compassion and taking the time to learn about our patients lives and their priorities as they approach the end of their life. The book also shows us the importance of patients and families having conversations to make the end of life more navigable and less agonizing for loved ones. Such caregivers should use the same questions Gawande uses as he is talking to his terminally ill patients, “What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?”. Asking these questions is a practical step towards transforming shortsighted, physical treatment into more holistic care which promotes the well-being of our patients. I hope that when I am faced with difficult situations like these in the future, and I feel that a conversation is needed with a patient that is under my care, I will have the courage and ability to ask the right questions. After reading a book like “Being Mortal” I feel more confident that this will be the case.