Being mortal: The essential conversation I didn’t have with my new doctor

 

Atul Gawande's book "Being Mortal" aims to change the end-of-life dialog between doctors and their patients.

Atul Gawande’s book “Being Mortal” aims to change the end-of-life dialog between doctors and their patients.

I can be a little slow on the uptake, but here’s something I know is true: my new doctor is a Christian. I am confident of this because he mentioned it several times during my recent getting-to-know-you visit in his office. At the time, I just smiled and nodded, as if he were saying he likes his eggs over easy. Different strokes, right? Today, I am kicking myself for having missed an important opportunity to learn what his Christianity means to him, and what it might mean for me.

Don’t get me wrong. I like this doctor just fine. I was referred to him, somewhat randomly, when my longtime physician, whom I adored, retired and closed his practice. This new guy has a pleasant manner and an intelligent face. He graduated from a respected medical school in my home state. He seems personally healthy, which is important in someone who very well could guide my own health decisions for the duration of my life. He’s articulate, has a gentle sense of humor and is gratifyingly fond of the Great State of Maine — although, like me, he is From Away. All of this is reassuring. But his repeated reference to his faith, I now realize, made me a little uncomfortable.

I am not anti-religion. Some of my best friends are Christians, some are Jewish, some identify with Buddhism and Hinduism, and not a few are Unitarian Universalists. As for me, although I am deeply drawn to the traditions of the Episcopal Church, when you get right down to it, I am an atheist. I don’t believe there’s some kind of cosmic consciousness out there, some supernatural scheme or intelligent design that explains the mysteries of life.

I do believe that science holds the answers, and that it is just a matter of time — maybe a long time — before all is revealed. I believe this is the one life we have, that it should be lived enthusiastically and authentically and relinquished with as much ease and grace as we can muster when our bodies wear out or become damaged beyond the reasonable ability of science and medicine to restore them. I am not afraid of death, only of pain, sadness and indignity at the end.

But my new doctor doesn’t know any of this about me. He didn’t ask, and I didn’t tell, even though we had the perfect opportunity. As far as I’m concerned, this is a failing on both our parts.

I recently finished reading the book “Being Mortal,” by Atul Gawande, one of the clearest-thinking writers I know. He also happens to be a respected surgeon at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School. Among his many gifts as a writer is the ability to distill very complicated issues down to manageable ideas, in language we can all understand, using compelling, true-life examples to illustrate his points. It’s an important book, and if, as a generally thoughtful and informed older adult, you haven’t read it, you really should. I’ll lend you my copy, if you promise to give it back.

Among other things, “Being Mortal” challenges the notion that the role of modern medicine is to defeat death and prolong life. It makes the perhaps subversive argument that a good death, an accepting death, is a kind of victory over a medical system that is more comfortable keeping “hope” alive in the form of yet another diagnostic test, another round of chemotherapy and radiation, another surgery.

These are, of course, deeply personal and individual considerations. Gawande’s bottom line is that in order to die a good death, we must clarify our convictions and end-of-life wishes to ourselves, our families and our health care providers. This means entering into conversations that can be awkward and uncomfortable for all concerned, but which are potentially among the most important of our lives. And it means allying ourselves with health care professionals who share our values, or who can at least honor and uphold our wishes.

I’m 61, in good health and loving every day of my life. I have no intention of dying any time soon. But death comes to us all, and with it, often, important decisions about how we wish to finish living. My new doctor asked me many questions at our initial interview this week, but he never asked if I have an advance directive (I do) or a healthcare power of attorney tasked with ensuring my end-of-life wishes are honored (I do).

And I didn’t ask him how his religion, which is clearly a central aspect of his life, impacts the medical decisions he makes. Does his Christian conviction allow for the compassionate discontinuation of life-support technologies like mechanical ventilators and feeding tubes, or is it a “pro-life” philosophy that would make that decision impossible? If I were nearing death and in pain, would he order enough medicine to keep me comfortable, even if it eased me closer to the end? Would he steer me away from risky interventions that hold little promise for improving my quality of life? Would he do everything he could to allow me to die at home instead of in a nursing home or a hospital?

These are important questions and I am astonished that I neglected to raise them in our conversation. I’m surprised that he didn’t bring them up, either. Clearly, one of us needs to pick up the phone and make another appointment. I’m guessing it’s going to be me.

Meg Haskell

About Meg Haskell

Meg Haskell is a curious second-career journalist with two grown sons, a background in health care and a penchant for new experiences. She lives in Stockton Springs. Email her at mhaskell@bangordailynews.com.