Being Mortal - Atul Gawande book review

"Our reluctancy to honestly examine the experience of ageing and dying has increased the harm we inflict on people and denied them the basic comforts they most need" Atul Gawande 

This is a post that I have been wanting to write for some time. However, due to the very nature of this book's topics it has been one that has taken me a significant amount of time to get through. By no means is this book boring, it is the complete opposite and dare I say it is to date my favourite book that I have read associated with medicine. It is a remarkable book that tackles the subject of mortality, one that many fear, and addresses ideas of ageing, dying and medicine's role in all this. 

"The simple view is that medicine exists to fight death and disease, and that is, of course, it's most basic task" 

Throughout the book Gawande has changed many of my views on medicine, before reading this book I was certain that the role of medicine is to prolong life. However, through Gawande's telling of many different patients who faced terminal cancers of many kinds has persuaded me quite easily that the role of medicine ought to be to enable people to live the best quality of life possible. In many cases this seems counterintuitive when sometimes the best quality of life is in fact not continuing chemotherapy or treatment. Gawande explains the importance of conversation, how regardless of how hard the conversation may be to talk about death, what people want in their last days, what their priorites are, is in fact extremely beneficial, and also proves how important communication is as a doctor. 

However what intrigued me the most in this book was the beginning section on nursing homes. I knew that they were possibly not the best place in the world, having visited one for a relative and also volunteering in a hospice. However, I did not understand their sheer horror for many of the elderly who stay at some, in the sense they are often denied the right to do what they really want. I loved reading of the pioneers who are attempting to change the stereotype of a nursing home and the weird and wonderful experiments they conducted as a result (a personal favourite being when Bill Thomas, a medical director of a nursing home, proposed the idea of introducing 2 dogs, 4 cats and 100 birds as pets into the home, with extradorinaiy results). 

“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.” 

However, the book overall has given me a new perspective on mortality, yes it is a scary thought, dying is something I fear greatly, but the idea that with the help of medicine one can try and die peacefully is reassuring. I am young, I haven't even started university, but this book to me is of great relevance, it has not only changed my perspective of the role of medicine, but it has also changed my perspective on life. Whether Gawande's aim of the book was this or not he has shown me to live for quality of life not quantity. 

I end that this book is insightful and moved me significantly, it is important and everyone should read it, to change their ideas on ageing and mortality. 

"In the end, people don't view their life as merely the average of all its moments—which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story."

*quotes all taken from Being Mortal by Atul Gawande* 

A quick catch up

It is fair to say that I have neglected this blog, and I am aware that this is not the first case. However, the past month has been extremely hectic, with finishing school for the christmas holiday I had to stage manage the school's pantomime which took up any free time I had in school during December. Once I had broken up for Christmas I was exhausted and needed time to rejuvenate, sleep and catch up with my family. I return to school on Friday and return straight to mock exams, so every moment now is being spent revising, so consequently blog posts have taken a break this past month. I hope you all understand, however I can report that I have been reading many articles on medicine and a some books too, which I will aim to include on my blog as soon as possible, I would just like to get my mock exams out the way first.

My thoughts on the antibiotic crisis

For any budding student slightly interested in medicine, science and any interested in current affairs the antibiotic resistance crisis would no doubt have found its way into your thought process at some point. I know it is often on my mind.

The crisis of antibiotic resistance is one that is often documented in the media, and it is in my opinion one of the biggest challenges that modern medicine faces. In 2013 alone, there were about 480 000 new cases of multidrug-resistant tuberculosis according to WHO, this to me is slightly terrifying as without antibiotics we return to the pre antibiotic era, where whether you survived tuberculosis or not was down to sheer luck.

It’s a situation where I am not sure what the answer is, and I don’t expect to know the answer quite frankly, I’m not sure anyone really does. There is of course things we can do as a society to prevent the situation escalating more than it already has, by not overprescribing or overusing antibiotics, having a general understanding of antibiotics and antibiotic resistant. However, I personally fear that it is a situation where antibiotic resistance will occur regardless of our efforts to prevent it, in fact thanks to Darwin and the theory of evolution we know this to be true. The selection pressure that is antibiotics will naturally cause bacteria to evolve to become resistant to them.

So what is the solution?

To me, with what many may call naïve optimism, due to my age, I would say let’s find an alternative to antibiotics. If you ask me what that is, I will tell you this; at the moment I do not know. Yet, I do have ideas and one of them is thanks to my EPQ project, it is called phage therapy, and I will not delve into the technicalities of it at this moment, for I want to keep my posts as short and snappy as possible, but I will say if you are intrigued or rightfully concerned by this global crisis, I say do a bit of research. Phage therapy is highly under researched and doesn’t have the best reputation due to past research and trials, but it is if anything a fascinating idea, and even if it isn’t a possible solution to this crisis it’s worth a look up either way.

India vs UK healthcare

India has the ninth-largest economy in the world by nominal GDP and the third-largest by purchasing power parity (PPP) [1] and despite this much of India still remains as a third world country. Over October half term I had the experience of visiting Goa, India for two weeks, the trip was predominantly to visit family. However, whilst I was there I was able to witness the huge cultural  difference of India compared to the UK, not only in attitudes towards lifestyle and people, but also a particular difference in attitude and approach to healthcare.

Unlike the UK healthcare is not free at point of use in India (i.e. there is no NHS), and as a consequence of this the attitudes to healthcare are very different, below I will outline some key observations I witnessed whilst in India:

·       I noticed that many of the people who were begging and living on the streets often had a limb missing or some form of disability. I believe that this shows how many of the poorest in India  are unable to afford healthcare, and often they are those who are most in need.

·       One huge contrast to me, which actually shocked me significantly, was the ease of buying medicines from a pharmacist that would require a prescription from a healthcare professional in the UK. I also say pharmacist very loosely, since the pharmacies themselves were normally a shack on the side of the road, and upon entering you would tell the pharmacist your symptoms, and they would return with an antibiotic or other medicine, at an extremely cheap price. For example, whilst in India I contracted the ‘delhi belly’ and my mum was able to buy medication for me at 30 rupies, which is about 30p. Whether the ease of gaining prescription medication is a good thing or not is up for debate. It certainly helps fuel the misuse of antibiotics and hence the antibiotic crisis. However, having said that I know that the day I woke up feeling extremely ill, I was very thankful of the ease of access to medication.

·       The final contrast I noticed was the public health campaigns, in particular the appeal regarding smoking. I would spend much of my afternoon, when the heat was unbearable, watching a movie, and I noticed that if within that movie a character was smoking, then a banner would come across the screen declaring that smoking was dangerous. I cannot remember the exact wording, but the banner in short explained how it can lead to serious health complications and even death.

Overall it is quite easy to say that the healthcare in India is extremely different to the UK, and it made me appreciate how fortunate I am to have a solid healthcare system in the UK. The NHS allows society to gain healthcare whatever your income, and to me it the fact that it is free at point of use is extremely important and extremely beneficial. I also think that the fact in India one can obtain any medication over the counter at such ease is a problem, as it gives rise to misuse, and of course resistance, which is becoming a huge issue in global healthcare. The trip itself was enlightening, and showed me just how different the approach to healthcare is for different countries.

[1] http://www.rediff.com/business/slide-show/slide-show-1-special-25-interesting-facts-you-must-know-about-the-indian-economy-/20130808.htm

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