Answer:
Dr. Atul Gawande explains that as a medical student, he was only taught how to save lives, not how to help patients cope with death. Although medicine helps people to live longer and happier lives, it also transforms aging and death into medical processes, according to him. Gawande wants to find out how people's perceptions of aging and death have changed, and how they can be strengthened. Gawande describes how modern medicine has helped people to recover from diseases, infections, and injuries that were once fatal. Also cancers that were once thought to be incurable are now curable. However, medicine has altered people's perceptions of old age, causing them to see aging as a failure or deficiency rather than a natural phase. People avoid discussing aging because it is an unpleasant topic, but this has resulted in problems. Even though people are living longer, most people do not save sufficiently for retirement, and there aren't enough geriatricians to care for the increasing elderly population, despite the fact that geriatricians significantly increase people's quality of life in old age. Lou Sanders and his daughter Shelley are the focus of Chapter 4. Lou moves in with Shelley as his health deteriorates and he can no longer live alone. He is, however, irritated by his lack of power over food, television, and when he can see friends. Shelley, too, is burdened with having to care for her father on top of raising a family and working, so they begin looking for an assisted living facility. Gawande explains how assisted living came to be: Keren Brown Wilson, one of the pioneers of assisted living, wanted to establish a place where the elderly could have both assistance and privacy and autonomy. Though assisted living was initially very successful—increasing people's autonomy without jeopardizing their health, it has since evolved into a stepping stone to nursing homes rather than a viable alternative. Lou spends a year in assisted living, but his health begins to deteriorate, so Shelley, amid Lou's protests, agrees to search for a nursing home. Sara Monopoli, a 34-year-old woman with advanced stage IV lung cancer, is an example he uses. Sara doesn't want to concentrate on survival rates, so her oncologist, Paul Marcoux, recommends a number of chemotherapy options (median survival is about a year). Sara goes through four rounds of chemotherapy, none of which improves her tumors, but the chemo does cause her immune system to be suppressed. She contracts pneumonia as a result, and her breathing becomes severely labored. Despite her protests that she does not want to die in the hospital, the relentless pursuit of treatment causes her to succumb to pneumonia and die in the hospital. Gawande emphasizes the importance of addressing a person's goals for the end of their life in the final two chapters, as he does with his own father, who is also a surgeon. Doctors find a tumor in his father's spinal cord while he is in his 70s. Edward Benzel, a physician, offers him surgery, but he also assists Gawande in determining his father's priorities. Benzel advises Gawande to postpone surgery because he understands how important his career is to his father. This puts his health ahead of the possibility of a longer life, particularly because he knows surgery might render him quadriplegic. Gawande's father will be able to operate for another two and a half years as a result of the operation being postponed, which is extremely important to him. As his condition worsens, Gawande's father is now ready for surgery. Even though the topic is complicated, he and his father have a discussion before surgery about what kind of end-of-life treatment he can tolerate. Gawande's father reveals that he does not want to be kept alive by a ventilator or a feeding tube, and that he is more afraid of being quadriplegic than of dying. This discussion is crucial because complications occur during Gawande's surgery, and Gawande uses his father's advice to tell Benzel to go ahead with the procedure. As a result, his father doesn’t lose any motor function and staves off his tumor’s progress for a time. Eventually, however, Gawande’s father grows worse, and he knows that he doesn’t want chemotherapy. He elects for hospice care and passes away soon after, surrounded by family. Gawande continues by stating that everyone should consider their expectations, concerns, and trade-offs when it comes to aging, sickness, and dying, and that any doctor should assist patients in having these discussions. Though addressing death is daunting, Gawande's most rewarding experience has been assisting people in their final stages of life.