What Matters in the End (All Along the Way, Too)
I love the opportunity on a long plane flight to read an entire book. Most recently, Being Mortal: Medicine and What Matters in the End, the New York Times best-seller by Atul Gawande, a physician’s thought-provoking exploration of the costs of focusing on aging as a medical problem rather than the existential life issue that it is. Gawande deftly explores the skewing of using medical technologies to prolong life (prolong the dying process) by two days or two weeks rather than o focus on the quality of life in the three months or three years someone may have in coping with a terminal diagnosis.
His suggestions about increasing well-being even while acknowledging being mortal can offer courageous wisdom for any of us, meeting any of the ups and downs we face in the process of living.
To stave off helplessness by letting people retain control of what they can, what to eat and when to eat it, how to dress and when to dress, who to be social with if one chooses and when to have privacy and time alone when one chooses. To use any choices we do get to make to strengthen a sense of empowerment and competence.
To stave off loneliness by creating communities of 12-16 people living in their own apartments around a common kitchen and living/recreation area, with any necessary professional staff doing their paperwork on the kitchen table.
Increasing the social connections in our lives is probably the single easiest way to enhance our well-being. Matthew Lieberman, Social: Why Our Brains Are Wired to Connect
To stave off boredom by bringing living beings – dogs, cats, birds, plants – into treatment facilities to provide companionship and sources of both comfort and play. We stay active, young, and healthy by interacting with other living creatures – and that’s true lifelong.
Gawande also explains two themes that underlie all of the above. Families and health care professionals having the “hard conversations,” asking and listening to how people want to move through the difficult decisions they may face, being realistic and respectful, but not ostrich burying one’s head in the sand because the conversation is outside of people’s comfort zone. Truly, having hard conversations is part of being resilient about any difficulty we have to cope with.
And…cultivating a sense of meaning and purpose in the day to day. (Studies show that residents of nursing homes given the responsibility for watering the plants in their room have less pain, more engagement, and live longer than residents who are relieved of that responsibility by staff.] The meaning and purpose can be on a small scale – continuing to mentor students even while dealing with a terminal diagnosis, or calling one friend every day to cheer them up.
He who has a why to live and bear almost any how.
– Friedrich Nietzsche
Gawande points to how individuals, families, the medical profession and society as a whole can shift the focus from perceiving death as a failure, of the individual and of the medical profession, to a natural, inevitable part of being human and being mortal, and using that awareness to craft a life worth living along the way, full of empowerment, connection, vitality, courageous wisdom, and meaning.
Encouraging. Inspiring. Resilient.