Write an essay tracking Atul Gawande’s evolution as a doctor. His perspective on how to advise patients who have serious or terminal illnesses seems to change over time. Why and how does that happen? What experiences helped him to modify his approach? Include an analysis of how your own views about confronting terminal illness and old age have changed from reading the book.
In Atul Gawande’s book “Being Mortal: Medicine and What Matters in the End”, a shift in his perspective toward mortality is developed. Gawande’s evolution as a surgeon is very significant and based on his numerous personal and professional experiences. Atul progressively establishes an interpretive relationship, promoting the patient’s autonomy and enhancing shared decision-making. This allows doctors to be aware of the patient’s goals and what is most important to them before presenting the options. He states that letting patients’ needs be a priority makes them in charge of their destiny, preserving their dignity, and leading to a more meaningful end of life. He also believes in the goodness of palliative care and realizes that trying to fight illness when we know it is terminal is not necessarily what is best for the patient. Most importantly, He mainly describes how being honest about mortality and the prognosis of patients with terminal illnesses is better than providing hope that is not necessarily present. Being honest and going through these deep conversations is not something Doctors were ever really trained for, but it is necessary to go through. In his book, Atul Gawande demonstrates his journey from being a doctor focused on curing to being a doctor who focuses on quality of life.
To begin with, 2 of Atul Gawande’s patients have marked great importance in the evolution of his method of caring. Over time, his perspective on how to approach terminally ill patients drastically changes, for the better. In his book, he initially stated, “Yet within a few years, when I came to experience surgical training and practice, I encountered patients forced to confront the realities of decline and mortality and it didn’t take them long to realize how unready I was to help them.” (14) This statement meant that Atul was never really ready nor train to confront the conversations of announcing a patient they had a terminal illness. Sara Thomas Monopoli was a 34-year-old patient diagnosed with metastatic lung cancer while 39 weeks pregnant. Atul remembers how unable he was to admit to her and her family that there was nothing they could do. He clearly knew that metastatic lung cancer was terminal. It was a conversation he was unable to have. Due to her youth, she and her family decided to fight the illness until the end. Sara was deteriorating more and more. She ended up passing away in the ICU without saying goodbye. If Gawande had approached this hard conversation, Sara might have had a more meaningful end of life.
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This experience opens Gawande’s eyes to how doctors engage in a sort of unrealistic thinking of being able to save Sara and having the family remain hopeful. He realized how the topic of death was greatly avoided by doctors. Towards the end of the book, Atul describes his experience with another similar patient where he applied better measures of facing mortality. The patient was called Jewel Douglass. Gawande applied the interpretive approach to discussing Jewel’s terminal illness. Instead of just offering the options in an informative way, he questioned her on her goals and know what she was willing to do or let go. She was willing to undergo some surgery but to take no risky chances. This affected the way Gawande treated her. During an operation to unblock her bowel passages, he realized it became too risky, and decided to step back, just like Douglass had specifically asked. She ended up being able to return home again, which was her ultimate goal. All she wanted was to spend her last days as a wife/mother/neighbor/friend rather than being at the hospital and undergoing harsh treatments of chemotherapy. She died in her sleep, in peace, with her family, rather than in an ICU setting. Atul stated, “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: 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?” (259) These two patients show the shift of perspective and approach Gawande used to promote well-being.
To continue, Gawande’s experience with his father helped him modify his approach. By living the side of the patient, he was able to see the difference between a good and better doctor. He received the opinions of two doctors and it allowed Gawande to realize something important. One of the doctors was trying to more or else convince his father to immediately get the surgery. The other suggested to wait until it is necessary. The first doctor was very irritated by Atmaram’s concerns and questions, while the other doctor was very comprehensive and answered all the questions. Gawande’s father developed a spinal tumor. He decided not to do major surgery. All he wanted to do was for his pain to be managed. He chose well-being over survival.
Also, this book has greatly enhanced my view about confronting terminal illness and old age. Five years ago, before I was in the nursing program, my grandmother was diagnosed with stage 4 metastatic lung cancer. I was not very knowledgeable back then, and all I wanted was for my grandmother to be cured and continue to be in my life. Today I now realized how doctors never really brought up the conversation of a terminal illness. My 74-year-old grandmother was convinced she could fight this, so she accepted every chemotherapy and radiation therapy proposed, without really being aware of what she was getting into. My grandmother was supposed to survive 4 months with no treatment. She survived 8 months of nausea, weakness, and being too fatigued to spend quality time with her family. His quality of life was poor. She was in denial of facing mortality for a very long time. Her goal was to die in peace at home, but she ended up dying in the palliative care unit at the hospital. Today, I reminisce about these moments, and I know that if it would’ve happened today, my view would have been very different. I still ask myself: is it really worth living 4 months more if they are to be lived in pain and suffering? As I am now studying to be a nurse and have already faced a lot of terminal and palliative patients, this book allowed me to enhance my view of mortality and recognize the struggles doctors and patient goes through when faced with mortality.
To conclude, Atul Gawande’s view on how to confront and approach terminally ill patients. He concluded that a meaningful end of life is better than prolonging a suffering life. His overall goal with this book is for doctors, other healthcare professionals, and basically everyone, to develop a different attitude toward mortality. His goal is to change the philosophy of health care from curing the disease to having a quality end of life, free from suffering. “Being Mortal” is an important book recognizing aging, death, and dying.
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