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.
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.
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.
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.
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.
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.
https://www.agingcare.com/products/being-mortal-medicine-and-what-matters-in-the-end-433866.htm
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.