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Thursday, 6 August 2015

Book review: Being Mortal, Atul Gawande (2014)

I've been struggling with what to do with this book for some weeks. In that time I haven't picked it up but I've been wondering whether it's worthwhile spending any more time reading it. As you can see from the image that accompanies this blogpost, I have reached about halfway through the book. Tonight I decided to go ahead and do the review and that I would probably not read any more of the book, after watching a segment on the ABC's The Weekly With Charlie Pickering in which the host spoke with an expert in end-of-life health. I mulled over the program when I woke in the night and got up to write a message to the program's producers.

The reason I wrote to the producers of the program is because of something that also really bothered me for a lot of the time I was reading Gawande's book. In both cases what was being ignored was something absolutely central to any discussion of end-of-life health, and that is the wishes of the carer of the elderly person, who is usually a spouse or a child of the elderly person. Gawande eventually - belatedly, it seemed to me - got around to dealing with this issue in his book, but on Pickering's program the figure of the carer was completely absent, which resulted in a program segment that was not worth much at all.

In the end the reason I decided to put down Gawande's book is that it is too culturally specific. In Gawande's case this just means that the book is about the US situation, which is a status quo that is quite different from the way things are run for example in Australia. A nursing home in the US is quite a different beast from a nursing home in Australia, for a start. The other big difference of course is that in the US the principal or his or her family are the ones who have to pay the entire cost of residential aged care, whereas in Australia the government pays all or at least a part of it, depending on the financial circumstances of the principal.

When it came down to it these mismatches made all the difference for me. I found myself physically screaming in frustration at one old boy who didn't want to go into residential aged care and who egregiously imposed on his poor daughter who was forced to make major changes to her life just to accommodate the wishes of a man unable to look after himself anymore. If I had been his daughter I would have had a stern discussion with him about what was possible and what was not on. My reaction shows how important it is for there to be third-party help for families such as the government supplies in many countries, but not in the US.

Nevertheless, having read Gawande's book I can now better understand the situation of an American friend of mine whose father lives in the basement of the home of his other daughter in the midwest. From time to time when time and finances permit my friend travels back to her home country to take over the caring duties, and gives her sister time off from them.

While it may therefore be deficient for non-US readers from many points of view, what Gawande's book does provide however is to give some insight into the specific kinds of activities that the elderly find satisfying. Where I left off reading was at the end of the chapter where an ambitious geriatrician introduces birds and other animals into a residential aged care facility. It's true that the elderly have particular affinity with animals, probably because that kind of relationship relies for its maintenance on very unambiguous and often purely physical modes of communication. The elderly find this kind of interaction reassuring because they often miss out on noticing more subtle social cues. So surrounding elderly people with animals seems like a useful thing to do. Of course, you'd have to first secure the support of the managers of the facility, who have to think about the wellbeing of staff as well as residents.

I found myself wishing that Gawande had written from an Australian perspective. While it is unfortunate for families living in the US that their government provides no support toward residential aged care, it's unreasonable to wish that their politicians would change their system. At least that's really a matter for Americans to deal with at some future time. 

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