I had read this book by Atul Gawande sometime in 2021 when the pandemic was still a rage and had quite some thoughts on it penned down on a paper which I discovered today . also looked back on the blog abandoned for so long so thought of posting the same.
I do wonder how much of the what the author wrote he stands by in his current situation more than anything
“Our textbooks. Had nothing on aging of fragility or dying “ – except maybe philosophy which ones have really – when we read textbooks, we live as if there are, but so many tomorrows so much to do and frailty is for others. Dying. Seems like the most distant thing. Of course, this generation unfortunately has had it all rammed into their youth by Covid.
But for us from the 90s when we read textbooks, of any kind, few would ponder on it as a near-term thing.
“What tormented Ivan Ilyich…. was the deception, the lie. All accepted that he was not dying …. He would only need to keep quiet and a treatment. Good would result “
“no one pitied him as he wished to be pitied as a sick child is pitied” – And this is, what is truly lacking in our medical institutions irrespective of the money. One pays or the doctors earns .
A thought to understand the patient rather than their disease category. Truly, they rarely these days even get the disease, right? The chances that he could return to anything like the life he had were zero, but admitting this and helping him cope with it, seemed beyond us.
If only there was someone, who would admit this and spare the patient, and sometimes the care givers the trauma. But no, in the current medical setup, this is considered a failure by all sides. So no it won’t happen.
“Dying and death, confront, every new doctor and nurse”. Do they really?
I wonder these days experiences with young giggling nurses in India and astute smart boys, ready to help for the right amounts. Make me feel they are more immune to it.
Doctor’s no idea. They have more polish and formal interactive scripts to mumble are used. But yes, when they started off the studying and practice, maybe – I remember once in a novel about doctors, I had read when young, the person speaks about imagining every disease on self-based on symptoms. And I had felt so empathic for that. Exactly why I decided, and I’m very glad not to pursue biology.
“There is no escaping the tragedy of life which is that we are all aging from the day. We are born.”
We all theoretically accept this. Once we are 30 plus, or minus. I think. But to confront and think and live based on accepting it is different. We push back and the body gives the aging signs beat looks or strength, till it really grounds us in Some way . Is to push back, right? i.e the victory of the spirit.
“ Lacking a coherent view of how people might live successfully all the way to their very end. We have allowed our faiths to be controlled by the imperative of medicine. Technology. And strangers, “
Considering this book is from 2014. I wonder how the author would defend this now when almost all the medical community wants to control the fate of this world en-masse by their vacs(aka1 ring) to rule them all, kind of discourse.
“But what if the sick in the aged are already being sacrificed – victims of our refusal to accept the inexorability of our life cycle. And what if there are better approaches right in front of our eyes, waiting to be recognized, “
He describes his grandfather’s old age in India, the ideal life catered to by the next two generations. I just think he missed watching movie Baghban, which when this book was published was the favorite movie of the generation who had catered to this idyllic life, hoping that they would get it too. Alas the world is off the idyllic ways.
But other than that, the description in the dilemmas and the facts, he describes of those living in the 60s to 90s is quite true.Age, had a power those days. The kind youth now has,
“whenever the elderly have had the financial means they have chosen what social scientists have called intimacy a distance”
Which I believe is why the grandparents then were happy to live in villages as long as the money is sent home but the next generation though wanted more. Money They have earned. They wanted the power of age, which sadly no longer is given in the current times,
The description of the old lady, as she lives independently, from late 50s to the 70s. And then finally, in the 70s still she needs help exposes the fitness fallacy. If you live long enough, however, fit you are at a given point, you’ll be a dependent. So all the health and fitness does prolong years of being independent, if you’re fortunate to be, not struck by random modern diseases, but at some point age, you will be bedridden or dependent.
And this explains why in India people put so much value in carrying on the generational legacy. That today’s generation is incapable of providing what they provided (willingly or unwillingly) is Something many are not open to come to terms with.
The causes may be many physical financial mental, but millennial generation, who seems to have the greatest empathy for every cause has the least ability to do the actual drudgery work. Sure They suggest brilliant technological ideas example Robot companies for the elderly completely. Ignoring the fact that these oldies they empathize with will actually want the actual sacrifice of their youth ,of their time effort and maybe all else and certainly not smart robots- for they believe, they sacrificed much, raising us and deserve that back. Sure there are exceptions which only prove the point .
For even the fittest independence is not sustainable. And once that’s gone, you’re just dependent on fortune / karma and all such for whoever you depend on be it children, servants , nurse but it’s their dependence, which will haunt those who go with the ever independent theory and that’s a hard thing to think through.
Was discussing with a friend whose mother being completely bedridden is completely taken care by her Dad and we all said she must have so much good karma as in that generation its hard to get men who would do that – sure , pay for servant , nurses and all but doing it by self rare. But the lady in suffering considers it her bad karma that she needs to depend on her husband of all the people for every bit of her life.
Sure death is the greatest liberator and that is why across millennia fortunate those that die young more so if that happens for a nobler, glorious course,
The greatest pain and tragedy of life is experienced when you just wait to die. Sure A few poets and cancer and other survivors hack, those last days best.
But if they were given a choice of a long medicated fight of survival for a few more years or an instant end to the whole thing – most would choose instant end to life or so I think – accepting that I may be completely wrong .
The book does highlight that no, such choice really was available in most of history,
“as Montaigne, observed ..to die. Of age is such a rare singular and extraordinary death, and so much less natural than others.”
“ When we study aging. What we’re trying to understand is not so much, a natural process as an unnatural one. Any particular reproducible pathway to aging? No. He said we just fall apart. “
The book focuses on USA. So the focus or need for geriatrics is understandable. Here in India? No, such discussion is done. If children don’t do what is listed by the geriatricians “ vigilance on nutritional ,medications.” well they are ungrateful and callous. That if they do also they are harassed for taking away their freedom is a different point.
“ The prevailing fantasy is we can be ageless the geriatricians demand. Is we accept. We are not “
some of the descriptions, he gives of a doctor retired, at 82. Describing his trouble, scare me at a age halfway of that . eerie similarities of the generation gap? Aging is faster ?
“used lotion to avoid skin cracks protected himself from heat. Saw dentist twice a year can’t think clearly as I used to”
“ if I go back and look at what I’ve read, I recognize that I went through it. Sometimes, I don’t really remember, I try to deliberately focus on what I’m doing rather than do it automatically. I haven’t lost the automatic city of action, but I can’t rely on it the way I used to “
The book discussed a lot more on how old age affects out thoughts and why today’s medical system is simply unsuitable for the same. A few more thoughtful lines
“Old age is a continuous series of losses. Old age is not a battle old age, is a massacre,”
“The systems we’ve devised were almost always designed to solve some other problem modern nursing home. They were never created to help people facing dependency in old age. They were created to clear out hospital, beds”
“Taking care of debilitated, elderly person in our medicalized era is an overwhelming combination of the technological and the custodial,”
“ the burdens for the today’s caregiver have actually increased from what they would have been a century ago.”
“ Home is the one place where you own where your own priorities holds way at home. You decide how you spend your time, share your space, and how you manage your possessions”
“ What makes life worth living when we are old and frayed and unable to care for ourselves. A theory of human motivation,”
“ What’s more our driving, motivations and life. Instead of remaining constant, change hugely over -time”
“ as people grow older, they focus on being rather than doing and on present them, the future. “
“How we seek to spend time may depend on how much time we perceive ourselves to have “
“when you are young and healthy you believe you’ll live forever as your horizons contract. When you see the future ahead of you as finite and uncertain the focus shifts to the here and Now to everyday pleasures and the people closest to you .”
“the simple, but profound service to grasp a fading man’s need for everyday comforts for companionship for help achieving his modest aims is the thing that is still so devastatingly lacking more than a century later.”
“ Many of the things that we want for those, we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.”
“ A medically designed answer to unfixable problems. A life design to be safe but empty of anything they care about “
“People with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a
sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars.“
“When to shift from pushing against limits to making the best of them is not often readily apparent. But it is clear that there are times when the cost of pushing exceeds its value“
FrozenThoughtz 