A WHILE ago, I witnessed the transformation of a private nursing home for the elderly by a new owner. It was in a house in a rural hamlet, surrounded by fields and farms. Until the arrival of the new owner, the elderly residents dozed in armchairs, placed in line around the walls of a large sitting-room. Even when we held services there, few of the residents managed to keep awake. I always found visits depressing.
The new owner changed this with a single bright idea. She persuaded one of the local farmers to lend the home some orphan lambs, which needed to be bottle-fed several times a day; and she asked the residents whether they would like to do the feeding. They were soon hooked.
If you have ever bottle-fed a lamb, you will know how satisfying it is. The lamb’s enthusiasm soon spreads to the feeder; even those residents with severe dementia joined in. Instead of dozing in their chairs, they eagerly took part, and even delayed bedtime to do so. They had regained a purpose in life.
Atul Gawande’s thoughtful book is full of similar tips. He writes in an easy style, and his stories attempt to convey up-to-date information about medical and communal care of old people. By profession, he is a surgeon in Boston, Massachusetts, and is the author of two popular books on surgery. Now he has branched out by listening to geriatric and hospice specialists, and visiting a number of homes. The result is a fascinating but sometimes challenging book, which is ideal for discussion groups.
If you are retired, as I am now, you will probably be most challenged by some of the early chapters. The first one gives a blunt account of how our bodies age from mid-life onwards. There is a moving and difficult account of a geriatric specialist, now in his nineties, who is experiencing medical complications that he has witnessed for many years in his patients. My father and grandfather were both doctors, and they were also somewhat bleak about their own old age. Perhaps it goes with the profession.
Another chapter on badly run homes for the elderly is also challenging — especially those places that make all the decisions for their residents, offer them little or no freedom to do as they wish (typically because they want to keep them safe), over-medicalise them, and leave them little purpose in life.
Again and again, Dr Gawande asks whether it is right to treat old age as a medical problem. He notes that some of his surgical colleagues are too ready to operate on elderly patients who are likely to get little or no benefit from surgery. He also agonises about “rationing”: allocating medical resources fairly between the young and the old.
There are interesting questions to ask about how well his predominantly American experience fits the NHS in Britain. There are places where this is clearly a very American, middle-class book.
Yet there are commonalities as well. In both of our countries, the advice to the elderly is the same: eat sensibly, keep fit, and get your blood pressure under control. And we have both experienced similar trends: our forebears typically died at home (think of all those Victorian deathbed-scenes), whereas now we are more likely to die in hospital, with tubes sticking out of us.
We are also both changing, however. Hospice care is flourishing in both countries, and, increasingly, palliative care is also delivered to our homes. We both face the challenge that, with increasing longevity, perhaps one in five of us is likely to experience dementia. The science fiction of medical immortality is at odds with the more likely prospect of the ineluctable deterioration of our bodies and minds.
There is little about faith in this book, although it does conclude with the author’s scattering his father’s ashes on the Ganges, in accordance with Hindu custom. And, just occasionally, the church connections of some of his patients are also noted. But his own concerns are more worldly: how can we improve the lot of the elderly, and restore freedom and purpose to them in this life? How can we make homes for the elderly more bearable?
People of faith will surely wish to go further than this. What difference does a sustained faith in God’s love make to old age? That question seems to be off his radar.
Will you enjoy reading this book? “Enjoy” is probably the wrong word. I think that you are likely to feel more mortal as a result of your reading. Dr Gawande is, indeed, frank about our mortal bodies. But he might also encourage a discussion about care arrangements (including organ donation) with our loved ones.
Instead of endlessly planning our funerals, it might be wise to give more thought to the prospect of dependency in old age. We all begin life as dependent mortals — and, like it or not, as the doctor notes, many of us will also end life as dependent mortals.
He is not the first person to point this out, but he does it well.
The Revd Professor Robin Gill is Editor of Theology and Professor Emeritus of Applied Theology at the University of Kent.
Being Mortal: Illness, medicine, and what matters in the end by Atul Gawande is published by Profile Books/Wellcome Collection at £8.99 (CT Bookshop £8.10); 978-1-8466-8582-8).
BEING MORTAL — SOME QUESTIONS
Do you agree that “there is no better time in history to be old” than the present day?
Does this book change our understanding of the commandment to honour your father and your mother?
Dr Gawande writes that “the very marrow of being human” is “to be the authors of our lives”. Do you agree?
Did reading Being Mortal change the way that you think about suffering?
The book suggests many ways in which doctors, patients, and families might better communicate with one another. Would any of these be useful in a church context?
In what way do you think that “understanding the finitude of one’s time could be a gift”?
Dr Gawande states that we are often “unready to confront the reality” of disease and death. Having read this book, how might we better ready ourselves?
Being Mortal makes a distinction between “a good death” and “a good life to the very end”. What do you think the difference is?
How important is the idea of home in this book?
IN OUR next reading-groups page, on 4 March, we will print extra information about the next book. This is Cold Comfort Farm by Stella Gibbons. It is published by Penguin Classics at £7.99 (CT Bookshop £7.20); 978-0-14-144159-7).
Cold Comfort Farm is a classic of English comic fiction: its influence is still felt in the way we write and think about the countryside. An instant critical and commercial success when it was published in 1932, Stella Gibbons’s novel was written as a response to the effusive “loam and lovechild” novels of authors such as Mary Webb. The action follows the efforts of an orphaned urbanite, Flora Poste, to modernise her country cousins the Starkadders — lusty Reuben, ethereal Elfine, the mysterious Aunt Ada Doom — amid the rolling mists and thickly growing sukebind of deepest rural Sussex.
Stella Gibbons was born in London in 1902. She wrote for the Evening Standard and The Lady before the success of Cold Comfort Farm led her to pursue a full-time career as a novelist and poet. Over a long literary career, Gibbons published 24 novels, including Conference at Cold Comfort Farm, in 1949, and four collections of poetry. None of her writing, however, attained the same level of acclaim as Cold Comfort Farm, which she came to refer to as “That Book” and “You-Know-What”. She died in 1989.
Books for the next two months:
April: Lila by Marilynne Robinson
May: Blessing by Andrew Davison