As Gawande points out, there is a “prevailing fantasy  that we can be ageless,” that, in time, medicine can fix what is wrong with us. It’s the same quest for miracles that, as I mentioned in my post on Anthony Doerr’s The Shell Collector, “fuels a $30 billion supplement industry that touts ‘cure all’ claims that are often based more on fiction than fact.”
The prospect of aging and dying is scary. Gawande, a general surgeon, doesn’t sugarcoat it as he lays out the lessons he has learned from his personal and professional experiences. He describes how our bodies fall apart, the accompanying loss of independence, and the double-edged sword of medical treatment in the final stages of life. There are stories from Gawande’s family and from his patients, including a 34-year-old woman with lung cancer and a nonagenarian who, as Gawande quotes in a much-needed moment of comic relief, would “vote for Dracula if he said he was a Democrat.”
I actually laughed a handful times while reading this book, which was otherwise a relentlessly bleak portrayal of how our society handles the needs of our aging population and the terminally ill. Not only are so many of our nursing homes and so-called assisted living facilities “depressingly penitentiary,” as Gawande says, but the medical establishment tasked with guiding us through the final years of our lives is woefully unprepared for the job. The percentage of the population over age 65 has grown (from 2% in 1790 to 14% today), while applications to adult primary care training programs have dropped and applications to higher-paying fields, like plastic surgery, have risen.
As a society, we have prioritized looking young over aging well.
However, Gawande notes signs of progress, indicators that more of us are now able to “remain the writer of our own story” to the very end. More people are dying at home or using hospice care, and there have been increased efforts to address the isolating nature of institutional care. As he concludes, “We’ve begun rejecting the institutionalized version of aging and death, but we’ve not yet established our new norm.”
So, what should this new norm look like? Does it include assisted suicide/death with dignity, which Gawande discusses only briefly in the book? What role does our government play in providing adequate legal, social, and economic support for those of us who are dying and our formal and informal caregivers?
One of the facts Gawande raised about caregivers particularly stood out to me:
Your chances of avoiding the nursing home are directly related to the number of children you have, and, according to what little research has been done, having at least one daughter seems to be crucial to the amount of help you will receive.
Thanks to the persistent stereotype of women as homemakers, the primary alternative to institutionalized care has been for women to care for our aging relatives. Without adequate support, so many struggle to work and raise children while also providing the type of care that enables our aging loved ones to write the ending of their life stories (PDF).
When imagining our “new norm,” let’s aim for one that allows us to end our lives on our own terms while also allowing our caregivers to continue to live theirs.
*See also To Sleep, Perchance to Dream (If You’re Unlucky?) (“There’s no better time of year to read a book about death—and America’s stubborn unpreparedness to care for its aging population— than fall.”)
**The pictures below were taken at Chanticleer, where I read the first 30% of this book.