October 26, 2018

The argument for palliative care

"...our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. ...you live longer only when you stop trying to live longer." - pg 178

I wanted to start with that quote from today's book because it struck me as being so shocking in its simplicity and yet it completely blindsided me with its poignancy. Being Mortal: Medicine and What Matters in the End by Atul Gawande is at heart a discussion of the ups and downs of treating the elderly through a variety of means whether that means aggressive medicine, nursing homes, assisted living, or hospice. It's obvious that the author has a great admiration for palliative care and a belief that all doctors/clinicians should be trained and proactive to deliver the best care for their patients. In essence, asking practical questions about what trade-offs patients are willing to make for ensuring good days ahead are key to excellent palliative care (for any age). He stresses that instead of simply giving all the options for care at the outset of a diagnosis doctors should instead ask a set of pertinent questions to get at what their patient really wants to have a good quality of life. This is relevant (and necessary) for patients whether they be elderly, terminally ill, or disabled. Gawande clearly knows his stuff (he is a doctor after all) and he was thorough in his research for this book as he interviewed across many disciplines to see what is being done by various agencies in the care of the elderly and dying. Apparently there is no one accepted method of care except to ask, listen, and respect the wishes of patients. According to Gawande, there is "...a still unresolved argument about what the function of medicine really is - what, in other words, we should and should not be paying for doctors to do." (pg 187) Hospice is not just an option for those who are looking for end of life help or to speed up death but is an excellent choice to make good days out of one's remaining life. My verdict: Very informative book that I kept picking up with great alacrity and I will definitely read more of his writing. 10/10

I'll leave you with this final quote to chew over:
"At root, the debate is about what we fear most - the mistake of prolonging suffering or the mistake of shortening valued life. All the same, I fear what happens when we expand the terrain of medical practice to include actively assisting people with speeding their death." - pg 244  

Source: Amazon

What's Up Next: The Science of Superheroes by Lois H. Gresh & Robert E. Weinberg

What I'm Currently Reading: The Bear and the Nightingale by Katherine Arden

**If you're interested in buying this book or any books really, you can click here or here. The first will re-direct you to AbeBooks and the second will re-direct you to The Book Depository. These are great websites for purchasing books (AbeBooks carries inexpensive used and out-of-print books and The Book Depository ships free everywhere in the world). Full disclosure: I will receive a commission on all sales made by following either of these links. I wouldn't recommend a site that I didn't use and you are under no obligation to purchase anything. :-) **

October 20, 2018

Raw, unfiltered, and achingly honest

When Breath Becomes Air by Paul Kalanithi is a posthumous memoir/biography from a man who was both in the prime of his life and the beginning of what promised to be an illustrious career as a neurosurgeon and neuroscientist. The terminal lung cancer which was already making its way through his spinal column wasn't part of the plan...and yet Paul chose to meet this challenge head-on as a way to understand and learn how the inevitability of death can be explored by those shepherding the way. How does the mind and brain (seen as two separate entities here) play a role in this? He first approached this topic through the lens of literature which he had always been interested in (hence the beginning of the book which would eventually be published after his death) but he then moved on to his direct experience as a doctor and then as a patient. Paul was interested in the bigger picture of what exactly death means and he kept trying to parse it out by asking, "Where did biology, morality, literature, and philosophy intersect?" (pg 41). He didn't shy away from the ugly underbelly of cancer treatment and how it's seen from both a medical professional's standpoint (best practices, proven remedies, etc) and the one receiving the care (uncertainty, despair, anger, and frustration to name a few). Facing mortality and asking the tough questions are the overarching themes of When Breath Becomes Air but this is also a quiet story about a man coming to terms with the fact his life was about to end. I don't want to give away all of the details because I really think you should read this one if you never read another book about death (although why stop here?). I didn't know if I'd be able to continue it at several points (there were tears) because it mirrors so much of what my dear friend, Jessica, went through during her battle with cancer. But I am happy that I persevered. 10/10

This quote blew my mind because I feel I'm constantly justifying to people why I do the work that I do even though some of it doesn't compensate me at all (the blog) and the one that does is probably never going to make me financially solvent (children's librarian). Looking at the bigger picture is hard if you are cutting out the crucial bits like death which comes for us all.
Indeed, this is how 99 percent of people select their jobs: pay, work, environment, house. But that's the point. Putting lifestyle first is how you find a job - not a calling. - pg 68-69
If I remember correctly this was a quote from Paul's wife and I think it perfectly encapsulates why this is such an important book. It's why I've read and reviewed so many books around this topic over the past year.
Paul confronted death - examined it, wrestled with it, accepted it - as a physician and a patient. He wanted to help people understand death and face their mortality. Paul's decision not to avert his eyes from death epitomizes a fortitude we don't celebrate enough in our death-avoidant culture. - pg 215
Source: Amazon

Side note of interest (at least to me): Lucy, Paul's widow, found love again with a recently widowed father of two...who's spouse also wrote a book about her journey of dying. That book is The Bright Hour: A Memoir of Living and Dying by Nina Riggs and yes it's totally going on my TRL.

What's Up Next: Being Mortal: Medicine and What Matters in the End by Atul Gawande

What I'm Currently Reading: The Bear and the Nightingale by Katherine Arden

**If you're interested in buying this book or any books really, you can click here or here. The first will re-direct you to AbeBooks and the second will re-direct you to The Book Depository. These are great websites for purchasing books (AbeBooks carries inexpensive used and out-of-print books and The Book Depository ships free everywhere in the world). Full disclosure: I will receive a commission on all sales made by following either of these links. I wouldn't recommend a site that I didn't use and you are under no obligation to purchase anything. :-) **

October 6, 2018

To stoke your wanderlust

Unruly Places: Lost Spaces, Secret Cities, and Other Inscrutable Geographies by Alastair Bonnett is essentially a sociological and philosophical study of what 'place' really means to each of us. The author explores 47 different locales around the globe (usually with GPS coordinates included) and divides them by type (floating cities, underground bunkers, and places without borders to name a few). He examines the dichotomy in wanting a place which is set in stone and also desiring to be itinerant travelers like our ancestors. Until I read this I had never really thought about the significance that we as humans associate with place. The historical and geographical facts Bonnett detailed were especially fascinating (examples include: pumice rafts, Sealand (they have their own passports!), and the enclaves of Belgium). The pacing was just right and the material kept me engaged throughout (which by this point in the year is a challenge).  I really like to learn about places that are far removed from the everyday and Bonnett delivered on that in spades. For those with wanderlust in their heart or a desire to learn about phenomenally odd and/or out of the way locales then this is a great little book. I bet it would make an excellent travel companion on any vacation! 10/10

Source: Amazon

What's Up Next: When Breath Becomes Air by Paul Kalanithi

What I'm Currently Reading: Star Trek: Destiny #3: Lost Souls by David Mack (yes, I'm still reading this)

**If you're interested in buying this book or any books really, you can click here or here. The first will re-direct you to AbeBooks and the second will re-direct you to The Book Depository. These are great websites for purchasing books (AbeBooks carries inexpensive used and out-of-print books and The Book Depository ships free everywhere in the world). Full disclosure: I will receive a commission on all sales made by following either of these links. I wouldn't recommend a site that I didn't use and you are under no obligation to purchase anything. :-) **