I recently read Being Mortal, by Atul Gawande, a surgeon at Brigham and Women’s hospital in Boston, and a professor at Harvard Medical School and the Harvard School of Public Health. Also a terrific writer, who has received widespread recognition for his skill with words. He is one of my favorite writers, and early in the history of this blog, I wrote very positive posts about three of his early books, Complications, Better, and The Check List Manifesto, which were about quality in medical care and how to achieve it. I recommend them as well as this one.
Being Mortal discusses the quandary of dying in developing countries. Most of us in the U.S. say we would like to die at home, And in fact in the 1940’s, most of us did. But by the 1980’s over 80 % of us died in hospitals, and the odds are that that is where we will draw our last breath, surrounded by sterility and technology.
Although we realize that we should spend the end of our lives enjoying our lives as much as possible, and looking back with pleasure at our lifetime experiences, we cling to extending them as much as possible. Hospitals are full of medical talent focused in exactly that direction—to cure, and extend lives. So we enter a hospital, subject to our hopes, which coincide with those of our doctors. The result may be that we die in a way that we would not have chosen —drugged and separated from friends and family.
Gawande argues for more sensitivity to the quality of our lives at the end, but realizes the possible conflicts between this and modern medical care, furnished by organizations of people trained to extend lives and proud of their skills to do so. This is being widely recognized these days, an appreciation that I am sure will increase as the Boomers reach the ends of their lives. This can be seen in the increasing visibility of hospice care, POLST (Physician Orders for Life Sustaining Treatment) forms, and other means of dying without being connected to a host of tubes and wires, or because they have finally been disconnected.
Medical care is another situation in which technology has reached a sophistication level that may not always be the answer. Traditional Navajo indian attitudes toward death were interesting. When a person died, their negative aspects (lack of harmony with the universe) went into a chindi, or ghost, which would hang around the site of their death and burial and infect those who became close to it with sicknesses perhaps leading to death. As a result, there was an advantage for a person dying outside of their living quarters, which otherwise would have to be destroyed to protect others from the chindi, but in an uplifting environment. Interesting that this approach would help slow down the spread of infections, such as the dreaded antibiotic resistant MRSA bacteria that hang around hospitals. Only a limited number of people (4) were involved with preparing the body for burial and disposing of it, and they were careful to purify themselves afterward. The chindi was to be avoided at all costs.
The author Tony Hillerman wrote a wonderful series of mysteries taking place on the Navajo reservation, and in them would occasionally have the hero breaking a dying relative or friend out of a hospital so that they could die at home, hopefully out of doors surrounded by beautiful scenery, not only consistent with their lives, but sparing the hogan from destruction. The hospital typically would furiously resist this action. I would think that the hospital would be all in favor of this, because it would soon have been populated by large numbers of chindi, to the detriment of all who entered it, sick or healthy. But medical people are trained to cure, and technology continues to make them more capable of doing so. And they generally do not believe in chindi.