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In my work with seniors and people diagnosed with a terminal illness, there is tremendous mystery regarding the experiences of aging and loss. The health care system dynamics are fraught with twists and turns that most of us are not equipped to handle. As people are working to navigate through the stages of health care, many losses will inevitably occur. People experience emotional loss, feeling a sense of no longer being themselves. And the family of the older adult or terminally ill suffer emotional turmoil from witnessing the losses the other feels.

Much has been written to try and help others navigate the system. However, as the system constantly evolves, the writing from even a few years ago can contain much that is outdated. A recent book, Being Mortal: Medicine and What Matters in the End, by Atul Gawande M.D., attempts to offer guidance from someone on the inside. His work takes readers on a journey of aging and end of life care through personal stories of people the author knew from his medical world and his personal world, including his father, whose dying he describes using both his professional and personal eyes. Gawande offers readers what he sees to be innovation around senior health facilities and residences, about offering dignity in whatever way is possible in the midst of decline and how we are all fighting a battle medicine cannot win, namely death. The book is a personal testimony of a doctor discovering a world beyond medical procedure for curative means.

While his book is well written and reads smoothly, I would like to also offer a couple of critiques for what I see would have enhanced his presentation. As he is a doctor, focusing heavily on physical healing, I think he sometimes glosses over the holistic aspects of care that he is trying to promote by not including more disciplines in his presentation. For example, in his conversation about hospice, he follows a hospice nurse, the case manager, to see how she works with a terminally ill person but we never see the rest of the hospice team. While he does inform his readers that hospice care offers psychosocial and spiritual support through Social work and chaplaincy, he doesn’t show us what that would look like. The same is true in his analysis of senior housing facilities. While reading about the place in upstate NY that innovated with offering residents pets to care for, I felt he narrows the focus of dignity to giving people a sense of responsibility and purpose. My experience has been offering people connection to faith and spirituality can also play a major role in reviving selfhood and dignity.

Even taking the above into account, I found this book engaging on many levels. As someone in the field of senior care and hospice care, his descriptions offered me much to consider in my professional role in caring for people. As a human being who has and will experience various aspects of life, I think his work reminds each of us that we need to be aware of the power of change, both good and bad, as we age and the one’s we care for age. There is no escape but there are ways to bring respect and dignity to our interactions with family and friends going through these stages of life.

(disclaimer: I was lent the book to read)

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