Being Mortal by Atul Gawande, discussion questions

Being Mortal (Paperback/ International Edition) 외국도서 저자 : Gawande, Atul 출판 : Picador 2015.09.01 상세보기

Gawande writes: “I learned a lot of things in medical school, but mortality wasn’t one of them.”

①    Are these books helpful, or do they do more harm than good?

 

Chapter 1, The Independent Self

①    How did Alice’s experience contrast with that of Sitaram Gawande?

②    What is your attitude toward old age? Is it something to deny or avoid, or a state in life to be honored?

③    Do you find that the respect given to the elderly has eroded? What is the value of being old?

④    What does autonomy mean to you? When you think about yourself aging, what kind of autonomy do you want to preserve?

* autonomy 자율성

⑤    Should we shield children from the realities of death? How should parents handle that?

⑥    Why do most people dread going into nursing homes? Do you think most Korean families can care for an elderly relative? Could you?

 

Chapter 2, Things Fall Apart

①    Gawande makes the point that sudden death is less likely than a slow decline in health and the inability to care for oneself, extending the process of dying. What are some advantages and disadvantages of each?

②    What can be done to encourage more doctors to specialize in geriatrics?

③    What has been your experience with your doctors? Do you find that your doctor hasn’t the time to spend with you?

④    Gawande discusses the movement from poorhouses to the rapid growth of hospitals, and to the development of the nursing home industry. Today we have many options:

• Aging in place (story of Felix and Bella)

• Moving in with son or daughter (story of Lou Sanders)

• Senior housing

• Assisted Living and Nursing Homes

Which one is the best option for you and your family?

⑤    What are your thoughts on ideal nursing homes? Should safety still be a priority?

Lou Sanders valued privacy and solitude. What are the deal-breakers for you?

 

Chapter 3, Dependence

①    As we age, we are bound to develop some type of frailty and eventually we die. What are your fears in this regard?

②    What would you consider a good death vs. a bad death: any experiences to share?

③    Are you doing anything to delay the disability that comes with the end of life? Do you feel prepared for the end?

④    How important is communication to you? When Bella lost her hearing, Felix hit a very low point. What do you think he would have done had Bella not regained her hearing?

⑤    This chapter gives new meaning to “There’s no place like home.” Would you be happy living in the apartment Alice chose? What would you miss most about your home?

⑥    Do you think some nursing homes are still similar to prisons?

⑦    What are the practical challenges for institutional staff to meet the needs of the residents who want to lead meaningful lives?

⑧    If you were in a nursing home, would food be the “Hundred Years’ War”? What would you insist on?

⑨    Thinking about yourself right now, could you imagine answering: “What are the tradeoffs you are willing to make and not willing to make?” - “chocolate ice-cream and football”

Chapter 4, Assistance

①    Shelly did the best she could for her father, but it took a toll on her and the family. Can you see yourself in that position? What conflicts did she face between her intentions and the practical needs of the family and herself?

②    “Living is a kind of skill. The calm and wisdom of old age are achieved over time.” Do you agree with this analysis? It took Cartensen a near-death experience to learn certain lessons. What wisdom have you taken time to acquire?

Chapter 5, The Independent Self

①    Lately, many nursing homes are including pets in residence of America. Thomas, it appears, went a bit overboard. Do you agree with his proposal? Do you understand why some administrators might be reluctant to have so many animals on hand?

②    Why did the addition of animals trigger so many improvements among residents? What do your own animals add to your life?

③    There is no discussion of what happens when one of the pets dies. If you were a nurse or assistant on the floor, how would you speak to a resident who may have lost an animal friend?

④    Do you have concerns for what happens after your death?

⑤    Have you found your priorities are changing as you get older?

⑥    Is it too much to ask of doctors to not only acquire technical expertise, but to also understand human needs? Should there be more courses in medical school?

⑦    Do you believe the concept of providing autonomy no matter what the condition is workable? Can we really be the “authors of the life we live”?

 

Chapter 6, Letting Go

①    When should we try to fix, and when should we not?

In Sara’s case, she and her husband did not want to confront her condition. They kept seeking treatments right to the end. How do you walk the fine line between being hopeful and being unrealistic? Acceptance and giving up?

②    How should priorities be set?

③    Why do you think it’s so difficult for doctors and families to refuse or curtail treatment?

④    What do we really expect of medicine? Do we really think everyone can be saved? Why do people have exaggerated ideas of the success of medicine?

⑤    The choice of hospice care is difficult for most families. What would be your criteria for yourself or a family member?

⑥    Cost and a system of insurance payment is a factor. If patients had to pay for end-stage care, do you think they would choose less? What are the pros and cons?

⑦    Do you think that advancements in the medical field damage our ability to have a quality end of life?

⑧    What personal traits do you think contribute to someone choosing and being successful at this nursing specialty?

⑨    Studies also found that, “You live longer only when you stop trying to live longer.” Have you found that you have been more successful in something you have tried to do when you stop trying so hard? Why?

⑩    How would you answer the questions on P. 179?

1.     Do you want to be resuscitated if your heart stops?

2.     Do you want aggressive treatments such as intubation and mechanical ventilation?

3.     Do you want antibiotics?

4.     Do you want tube or intravenous feeding if you can’t eat on your own?

 

Chapter 7, Hard Conversations

①    They also found that “just talking” had a beneficial effect. In your life, have you found that just talking helped in a difficult situation? Can you just talk without offering a solution? Is that hard to do?

②    Does your family know what your priorities are? What help have you provided them for when the hard decisions occur?

③    Do you really want shared decision making? Should someone control your impulsive decisions – save you from yourself?

④    What are some other hard discussions families should have?

⑤    Gawande describes three modes of patient interaction by doctors:

1.     The doctor knows best approach.

2.     The informative approach

3.     The interpretive approach

Put your doctors into one of these categories.

⑥    Would you prefer hospice care in your home or the “village” approach of places like Athens Village? What are the benefits or shortfalls of each?

⑦    Do we underestimate how much activity someone who is elderly or terminally ill can achieve? Has someone you know amazed you with their ability to achieve goals even in the face of serious illness?

 

Chapter 8, Courage

①    In Plato’s dialogue, the question is asked: What is courage?

What is courage to you? Can it be physical, mental, emotional – just foolish?

Plato offers a few definitions:

- Endurance of the soul

- Wise endurance

- Knowledge of what is to be feared and what is to be hoped

- Courage is strength in the face of knowledge of what is to be feared or hoped

With which do you agree?

②    Have you ever had to be courageous?

③    How do we strike a balance between fear and hope, while still confronting reality?

④    P. 238, Gawande talks about our tendency to define our experiences in terms of the endings. We remember the end of a game, for example, by the last few plays or the final score, even though the entire game may have been pleasurable. “Life is meaningful because it is a story,” but even though we have a sense of “whole,” endings matter.

Why do we seem to neglect the journey and cling to the endings – of games, movies, books, etc. and our lives?

⑤    What would be your own “perfect ending”?

⑥    How do you feel about assisted suicide? It that a way to a perfect ending?

- prolonging suffering v.s. shortening a valued life

⑦    Would assisted suicide be a wise choice? What would be the impact on the family and friends?

  

Epilogue

①    Gawande tells the story of his father’s cancer, treatment and death. Do you think it was difficult to write his story?

②    His father rejected the first doctor, who had experience and expertise, in favor of Dr.Benzel, who took time to talk with him. Was this a risky decision? Would you reject a doctor with excellent credentials in favor of one with good “bedside manners”? What would guide your decision?

③    Just because we could, does that mean we should?

④    What should be the responsibilities of the family, doctors, and other staff?

⑤    Have you changed your thinking about end-stage illness, old age, and other catastrophic conditions?

⑥    What tradeoffs would you agree to in favor of continued treatment?

⑦    Will you take any actions based on what you have read and discussed here?

⑧    Would you recommend this book to others? Who? Why?

For more information on A Summer Read, visit Transforming Health.org

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