Last Updated: 10-28-2015
Over the summer, I read “Being Mortal” by Atul Gawande. I have thought about the book almost every day either in my own reflections of life or talking to a client about it. I did write my thoughts as a veterinarian on the book, with pen and paper, back in September when my computer crashed. Being a big recycler, it appears that I recycled the four pages that I wrote one night before turning in. So much for my career as an author!
Alas, I am back here at the keyboard of my new MacBook on a day off back at it again.
In Atul’s latest book, he delves into the struggles of human medicine and humanity. Yes, we have had huge advancements in medicine and surgery in both the human and veterinary world.
Yet we are still humans and death will come. There are as many people over 80 in the United States as there are under ten. The promise of a life worth living is a whole lot brighter for the eight year old vs the eighty year old. With medical and surgical advancements, there is an almost endless list of diagnostics we can perform as well as treatments. Atul examines the dynamics of nursing homes and assisted living facilities in the United States. Nursing homes may be devoted to safety and preservation of the “residents,” but if there is no quality of life, would you want to be there?
But what can we do for the elderly parent and loved one that cannot care for themselves anymore and may be in pain and suffering? Have them live in the hospital or rehabilitation ward? He interviewed amazing pioneers in assisted living facilities that give residents reasons to live and the freedoms to do it despite limitations. The animals that have become residents as well give the people a reason to get up in the morning.
As a surgeon working with cancer patients, he took a hard look at his own approach to his relationships with his patients, and the hard conversations about end of life. He writes of doctors that are paternalistic, the authoritative doctor. The vulnerable elderly, frail, uneducated does what they are told. The informative doctor can rattle off facts and figures. It’s the “cookie cutter medicine”. Two medical ethicists, Ezekiel and Linda Emanuel describe a third type of doctor, an interpretive doctor. This type of doctor not only gives you the options but asks what is important to the patient. Is there fear? Is there worry? What is the priority? Despite these teachings being taught in medical schools, it’s typically not what we see or share when we are in the throes of healthcare these days.
Throughout reading the book, I kept thinking to myself how grateful I am to be a veterinarian in a practice that I have cultivated over the years. My client is the advocate for their pet and I need them to be an educated participant in this thing called life! I love how I have developed the confidence to talk openly and honestly about pet care and quality of life even when it may not be the outcome that we hope for.
Atul Gawande’s book has the the subtitle “Medicine and What Matters in the End”. As a veterinarian, the “end” of our patients lives comes much faster than with our human counterparts. Yes, we all have the expectation and hope of living a long health life and wishing our pets could be with us forever. But life was not designed this way and the end of life is a certainty just like taxes. It will happen.
Since our pets are truly our dependents for their entire lives, we really are their guardians to provide for them. In return, they offer us companionship, love, loyalty. I want clients to assess their quality of life whether they be 2 or 15! Our quality of life can often be mirrored in our relationships with our pets. Even in our small practice, the end of life/death is encountered weekly if not daily. It can be saddening and heart wrenching, but I also feel that it has been one of the greatest gifts of my career because it really reminds me of the “present” of today.
When faced with medical and surgical decisions, I try to be an advocate for the pet first and then the guardian. Our pets are lucky in that they don’t “google” their symptoms and trigger the emotions of “what ifs”. They do sometimes wonder why all the vet visits are happening. When faced with advanced diagnostics, we talk about what will be gained with the information. With our holistic approach, I always try to focus a bit more on the therapeutics and things we can do to enhance life, not just prolong it. To me, euthanasia can be the greatest gift a client can give their pet when the essence of life can no longer be had. No, it’s never easy but the peacefulness of a beloved pet being surrounded by family as it transcends to dog or cat heaven can be such a heartfelt experience.
For many of our clients, a pet’s death maybe their first experience with death of a loved one, and the opportunity to reflect on “life lessons” we can get from our animals. You have seen these on posters and cards. Love unconditionally. Be loyal and supportive. Be quick to forgive. Live in the moment. Protect the ones you love. Follow your instincts. These are sayings, but they can also be actions that we can live out in embracing our own mortality.
Take some time to read this book. Make the effort to have those conversations not only about your pet’s life but also about your life with your loved ones. Know that you can’t control your mortality but I feel you can shape it into the imprint you leave on this planet.
Be well and enjoy today.