My friend and I frequent a quaint little café near our apartment in Columbus because of a delicious coffee beverage called the Vienna Kaffee. We also call this café as the ‘Old People’s Café’ because whenever we visit this café, we see a group of the elderly bent over their coffees, or relishing a delectable dessert. Oftentimes, I have wondered at the lives of these elderly, whether they live alone, whether they have caretakers, and their ability to drive despite their evident frailty.
People normally avoid discussions because the topic of aging does not exactly qualify as dinner table talk. Except that my friend and I had not avoided it. She once asked me for my thoughts on old-age homes and the concept of caring for the aged in India. I replied that because families are close-knit in India, it is a rare occurrence for families to give up their parents and grandparents to old-age homes. She mentioned that in Lithuania, where she comes from, families also take care of the aged. Then without batting an eyelid, she said, “when it is time for me, I would consider getting myself checked into a home”. I uncomfortably avoided saying anything because I had not thought about how I would prefer to spend my old age and mumbled something along the lines of,‘ I do not know..it is not for me’. I vaguely knew that the prospect of checking into a home is depressing. Living alone in an old age home away from my family was not how I would want to spend my old age.
Three months since this conversation, my sister and I chanced upon Atul Gawande’s book, Being Mortal: Medicine and What Matters in the End. I steeled myself to read about unpleasant and gory medical stories. After all, there isn’t anything pleasant about aging. Even medical schools agree and do not train students to care for the elderly. Gawande writes, ‘There is nothing glamorous about aging and the purpose of medical schools is to, teach how to save lives and not how to tend to their demise’. Doctors are trained to treat diseases and ‘figure that the rest will take care of itself’ because aging in a nursing home is ‘not exactly a medical problem’.
In tracing the evolution of care for the aged, Gawande takes us to poor houses, old-age homes, and nursing homes, and all of them, invariably, hold unhappy patients. (I previously did not even know the difference between each of them). In one particular striking paragraph, he compares nursing homes to prisons, where inmates have to wake up at a particular time, eat at a particular time, work and rest for a particular number of hours, and then go to bed at a particular time. Gawande argues that a loss of basic independence and functionality in nursing homes makes patients listless and they live a life without any meaning, which makes the entire concept of nursing homes deplorable. We are, after all humans; we all seek, merely, not to live, but to live meaningfully.
Gawande also challenges the notion of ‘being a fighter until the end’. If being a fighter means being hooked to machines with tubes running inside and outside of the body, is it really worth it? Aggressive medical intervention can prolong life, but at a terrible cost of misery following the patient until the end. At times like these, a simple talk about a patient’s choices helps. But the sad truth is that doctors are ill-equipped to talk to patients about their options for approaching death- after all, they are not trained to do that and would that really be their job[a]?
This is where hospice and palliative[b] care steps in- this is care provided to patients in their homes and eases the pain of the patient as the end nears. Here Gawande delves into the hard questions of how a person envisions their final days (I would have liked for Gawande to write about how these decisions are made for people who are not capable of making these decisions themselves). His account of his father’s suffering dealing with a tumor growing inside the spinal canal is moving and brings to light the finality of life after dealing with the hard questions. He asks his father, ‘what are your goals, what are your fears in case you are paralyzed, and what are your goals if your conditions worsen?’ In a poignant description, Gawande writes, “Those questions were among the hardest I’d asked in my life. I posed them with great trepidation, fearing well, I don’t what- anger from my father or mother, or depression, or the sense that just by raising such questions I was letting them down. But what we felt afterward was relief. We felt clarity”.
In helping his father deal with the end of his life, Gawande himself transforms. From shiftily trying to avoid the conversation with his patients, he now says, “I’m worried”. And that seems to make all the difference.
While reading Gawande’s book, I realized that I should think about my mother who lives alone and stoutly refuses any kind of help. She is fiercely independent, but has been suffering from a long list of ailments since many years. Gawande writes that when become old, they want to spend more time with family because relationships become valuable. The same also holds true for young people who survive a life-threatening situation. Family becomes a priority over ambition or wealth, and Gawande wonders if this alteration can reach people before they are struck by a calamity to reorient they way people live out their lives. I am a student on the of starting my career, grappling with several decisions about my life, my goals, and my dreams. I want to travel to every colour and shape on the globe. I am still not closer to making a decision, and I don’t know whether I will be able to make one. But, somewhere, at the back of my mind hovers a nagging thought that I should be going home to my mother.