The mechanisms of our demise have changed dramatically in the half century since my internship in medicine. Diseases that once were rapidly fatal can now be placed in remission, often for years. Advances in treating heart disease and malignant disorders, in particular, have reversed grim outlooks of a few decades ago. Dementia is an exception, and researchers still seek breakthroughs in treatment.
Instead of abrupt drop-offs in our health, we are more likely to have years in which our physical, and sometimes mental, capabilities will slip gradually until we reach a point where it may be difficult to maintain independent living in our homes. Increasing dependency places complex physical, emotional and financial burdens on spouses and close family members. Despair may erode the family environment.
Until the 1980s, a nursing home was often the solution by default to these problems. Such homes were designed for disabled people who needed extensive, chronic care. They varied widely in cost and quality, and their goals were to provide safety, nutritional meals and oversight of daily activities. But residents often felt isolated, bored and purposeless; they were marking time, waiting to die.
In his invaluable, new book, “Being Mortal: Medicine and What Matters in the End,” surgeon Atul Gawande traces the development of an array of fresh options to consider when our health or the health of a loved one is in decline. In intimate conversations with a variety of people whose lives are limited by strokes, progressive cancers, chronic heart failure and other disorders, he learns that each person desires as much autonomy as possible to continue to live a uniquely personal life.
For one man, a weekly cribbage game with a friend gave continuity to his life. A piano teacher with progressive cancer wanted to maintain contact with her students through weekly lessons. Life might be restricted, but it was not at an end.