ArticlesBlog

Dr. Atul Gawande on Aging, Dying and “Being Mortal” | FRONTLINE

Dr. Atul Gawande on Aging, Dying and “Being Mortal” | FRONTLINE


One of the reasons I write is
it gives me my chance to dive into problems
that I’m very confused about. I’ve written about, you know, “What are we supposed to do
about the cost of health care? “Why is the malpractice system
so crazy and what’s the way
it should be?” I’ve written about,
“Why do we itch?” You know, if it’s confusing
and interesting to me, writing is my way of diving in and figuring out what to
at least think about it. And this was one
of the big ones. The two big unfixables
are aging and dying. You know, they’re not… You can’t fix those. We’re afraid of talking
to the patient about these problems as well. A lot of doctors feel like, “I know how to have
this conversation. I know exactly what I’m doing.” But what I knew, what I could
see over and over again, was that we weren’t particularly
good at handling people going through the last days
of their life. I’ve had to learn that
because of patients with whom, you know, they did not end up
with a good experience at all. And then I’ve had to learn it
the hard way because of my dad. Do you remember when Dad first
started to get pain in his neck? Instead, what they found was
a tumor– a huge tumor. I remember I took notes
in my journal around that time. This is my dad saying,
“The way things are going, I could be bedridden
in a few months.” The tumor had extended
into his midbrain. The suggestion was that
we should go see what options there might be
for chemotherapy. So the oncologist lays out
eight or nine different options, and we’re swimming
in all of it. Temozolomide, vincristine,
vinblastine. And my dad says, “Well,
what if I don’t take any?” And she said,
“Well, that’s your choice.” Then she started talking
about how, you know, “You really should think
about taking the chemotherapy. “Who knows? You could be playing tennis
by the end of the summer.” And that was crazy. It made me very mad
because it was… Completely not right, yeah. This guy is potentially
within weeks of being paralyzed. It was holding out a hope
that was not a realistic hope in order to get him
to take the chemotherapy. The oncologist was being
totally human, and the oncologist
was talking to my dad the way that I had been talking
to my patients for ten years. But hope is not a plan. And in fact,
we find from our trials that we are literally
inflicting therapies on people that shorten their lives
and increase their suffering out of an inability
to come to good decisions.

Comments (25)

  1. Stay the course, Dr. Gawande, you are helping us through the maze. 

  2. I lost my father in law like that. He was diagnosed with CA lung with mets. Then under the onchologist's guidence we took the option of chemotherapy which I feel hastened his death also affecting his quality of life. Me and my wife both are docs so all the decisions about him were left to us. And I am afraid we took the decisions like any other human, just clinging on to that false hope. That was just hope and not a plan……… and it all went wrong.

  3. Insightful and compassionate piece from Atul Gawande. And thanks John Oliver Coffey for the link to the New Yorker article – excellent!

  4. Maybe it's time to explore other therapies that are not so invasive and don't involve negative side-effects: Therapies that don't shorten life, but extend life as well as quality of life. Have you watched www.thetruthaboutcancer.com? It's a documentary interviewing 28 doctors, 11 scientists and 9 cancer survivors. 

  5. I wish and wish I had known this before my brother passed with cancer after having been inundated with well–meaning but completely unnecessary and painful procedures and the regret is all-consuming for me and his daughter.

  6. Good stuff Dr Gawande – we need to resolve these existential issues and we have to stop the suffering. Dying with dignity is important.

  7. I thought Obama care make us immortallol

  8. Raises some very compelling issues. Thank you for sharing this.

  9. Hope is not a plan. We find from our trials that we are literally inflicting therapies on people that shorten their lives and increase their suffering out of an inability to come to good decisions."

  10. Definitely someone to follow.

  11. Thank you for writing your book and continuing to share the story of letting people live out their lives the way they want to. The discussions are neccessary to know what that is. 

  12. I have learned and continue to learn many things from people who are living with advanced cancer #WhatMattersMost : https://welcometomoyatown.wordpress.com/2015/02/09/my-priority-to-chop-vegetables/

  13. I've dealt with loss and death all of my life, since I have dogs.  We are ALL of us, EVERY day, coming closer to death, and it could be today with a car accident or coronary.  To wait hoping that we always have more time is foolish, and people need to understand that.  ALL of the people on this show have had a far happier and better life than I have, yet at the end all they can do is be bummed they can't live longer/forever.  How very very sad, at least my end will be well met after a life spent for other creatures of God.

  14. I work with Dr. Gawande He ia a very good Dr. and he is very good at what he does!!!

  15. From  Saudi Arabia.

    Thank you,

  16. We actually will one day be able to hijack the aging process as we are already finding out ways to do that. And there is this hormone called MELATONIN.

  17. Love this Dr, he has a lot of compassion.

  18. Wait a second though, why do we itch?

  19. Long live the hospice movement!

  20. Guys talk about chemo I talk about Cannabis use of course

  21. This is the first doctor i ever seen who has compassion for his patients. Now most docs these days are young and very cold.

  22. you have to be simultaneously detached and yet compassionate to tell someone they are soon to be dead.

  23. Wish you were close by. I think you would be a great choice for a Doctor.

  24. Treating symptoms not causes. Healthcare never sees the elephant in the room.

  25. Jai Maharashtra, Gawande saheb!

Comment here