There were a lot of subjects that Atul Gawande, MD, MPH, learned about in medical school, but mortality wasn’t one of them.
“My professors, fellow students, and I thought we wanted to learn about how the human body works, how it goes wrong, and ways we can fix it,” said Dr. Gawande during a recent lecture at Brigham and Women’s Hospital (BWH). Dr. Gawande is a renowned BWH surgeon, writer, researcher, and executive director of Ariadne Labs, a joint center for health systems innovation at BWH and the Harvard School of Public Health.
After caring for patients nearing the end of their lives and contending with health problems that couldn’t be solved, Dr. Gawande felt he didn’t fully understand how to be helpful in these situations. Wanting to learn more, he set out to interview patients, family members, physicians, home health aides, and others from BWH and across the country about what matters in the end.
Through these interviews, Dr. Gawande came to understand that many people have priorities at the end of their lives besides simply living longer. He suggests that a reliable way to determine these priorities is to ask patients, using the following questions to guide the conversation:
- What’s your understanding of where you are in your illness?
- If your condition worsens, what are your goals?
- What are your fears and worries for the future?
- What outcomes are unacceptable?
Dr. Gawande, author of Being Mortal: Medicine and What Matters in the End, gave examples from his book of people who only had months to live but still maintained the quality of life that was important to them.
One of those people was his neighbor and daughter’s piano teacher, Peg, who had pelvic cancer. Though her treatments stopped working and her cancer spread, she told doctors and nurses that she didn’t want to die in a hospital. She wanted to go home and focus on each day that she had left. After making adjustments to her medication schedule, physicians were able to get Peg’s pain under control so she could focus on teaching piano again, something she loved. She lived for six more weeks with hospice care and died peacefully at home.
“I think, in medicine, we have forgotten how incredibly vital it is for people to be able to pass on wisdom and keepsakes, connect with loved ones, and make some lasting contributions to the world at the end of their lives,” said Dr. Gawande.
Watch the following preview of the PBS Frontline documentary featuring Dr. Gawande:- Kim H./Jamie R.