While reading I debated whether to write a review or not. In the end, I guess I’ll just note down some thoughts as I ran through the book towards the end.
It’s not easy to avoid thoughts. All those you loved and have lost, those grandparents, those uncles, keep floating in and you do end up evaluating the end of their journeys against what Gawande has to say.
I couldn’t help thinking of Thatha, mom’s father, who passed away at home, after struggling with all kinds of organ failures for months. I remember the talk of how the last hours of his life were peaceful and he got to eat and live normally for a few days. I thought of thatha (dad’s father), and his last days, and how he refused to be fed by his daughter, angrily insisting that he’ll sit and eat. More than that I thought of my Ammummais, both of them without any memory or consciousness in their last days, in hospitals, passing away alone as everyone else was at work, or just about reaching the hospitals from home. It isn’t easy, the business of growing old and dying. As he says, you have a trajectory of normalcy and then blips start showing in the graph and you go in a final flurry of suffering, tied to multiple machines in a hospital.
Am still in my 30s, but I can’t help being increasingly aware of my own mortality. Much more than when I was in my 20s, at least. I think of my parents and wonder about their support system in my absence. I know many who are close to me say that I obsess over them, and put them at a higher priority than needs to be, but I really wish I had an answer, or a balance. Unless you’re talking of clear moral rights and wrongs, how do you draw a line?
I thought of different inputs over time. That wasn’t hard. I do actively seek out topics like this. There was The Ballad of Narayama(1958), told in Kabuki style of a village where when a person reaches 70 years, he/she is taken by his/her son on his shoulders and left in the mountain of Narayama to starve to death. A constant cycle of birth and death, strictly controlled in a village where food is a scarcity. And yes, I wept through most of the movie.
I thought of Summer Hours (2008), about a lonely parent and faraway children, and the very clichéd, but quite true – life goes on – in the face of inevitable death. The endless cycle in a way. How else would we be alive today, from some ancestor thousands of years back.
There was Tim Kreider’s excellent essay on growing old and the lack of romanticism in incontinence and dying memory. Ah, how much I relate to him!
There was, of course, Michael Ignatieff’s Scar Tissue, which deals mostly with Alzheimer’s and memory loss, but nevertheless evokes strong feelings for me.
I thought of Jerry Pinto’s Em and The Big Hoom, mainly for the strong bonds that sustain families and get them sailing through rough waters.
About the book itself, even though the topic is heavy, the author does a great job of keeping it flowing. There are more case studies and actual patients than constant lecturing, which helps. With medical non-fiction, have always liked a “show and tell” approach, and it works surprisingly well. Maybe we just relate to people and their experiences better than to concepts. I found it touching that he actually practised the whole idea of letting his father have a choice in how he wanted to go and did ensure he had a good last few months, at least as good as could be allowed. Am not too religious, but I somehow liked the ending being in a boat in the middle of the Ganga.
I do understand the idea of letting people choose, but as he himself points out, it isn’t always easy. Yes, there are ways to ask the questions, but can everyone articulate a correct answer? As he shows with one particular patient, the tradeoffs aren’t always clear. And more importantly, how easy will it be to let go and say “I did the right thing”? Won’t there be regrets? Or worse, relatives who want another approach to be taken, and can be surprisingly aggressive about it.
In death, as in life, I guess there are no easy answers.