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Op-Ed: Being Mortal | Batavick

Frank J. Batavick | CNBNewsnet

We are all on the same arc—birth, life, death. Of course, we don’t have any control over the first Unknown stage, and sometimes the last can come unexpectedly, like a clap of thunder. But we can all be rulers of our own domain during the middle stage, especially if we subscribe to humorist Leo Rosten’s belief that “The purpose of life is not to be happy—but to matter, to be productive, to be useful, to have it make some difference that you have lived at all.”

It turns out that this philosophy is also essential to the final stage of our arc, death. If we are granted a long life, we all want and need to feel productive and useful until the very end. But sometimes this end can get messy.

I just finished reading the 2014 book, Being Mortal by Atul Gawande. It was a gift from my oldest daughter, and became quite a sobering experience. Gawande, a surgeon at a Boston hospital and a successful author, wrote the book after the death of his father following a long illness. His central thesis is, “The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually it wins. And in a war you cannot win, you don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won, and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.”

Being Mortal argues against artificially extending life with ventilators, feeding tubes, radiation, chemotherapy and medications if it only prolongs the suffering and pain and doesn’t return one to feeling productive and useful. Gawande notes that too many people hold on to life so desperately that they cease “living.” If they’ve lost their mobility, capacity to enjoy food and drink, and ability to engage the world they knew, then they are experiencing mere existence and not life. Often, it’s one or more family members who are to blame because they can’t bear the thought of the aching emptiness that follows losing a loved one. This is a very understandable response, but one that often leads to needless suffering and the dribbling away of resources that could better serve a surviving partner or the next generation.

As a doctor, Gawande advocates using all medical means to prolong life. If a treatment punches your ticket to live another two, five, or ten years, then that’s a blessing. But there comes a time when death’s superior forces are grouped and poised to seize victory, and it is senseless to engage in battle for even one more day.

In working with experienced hospice nurses, Gawande was taught a series of questions to ask terminally ill patients to help them decide the best route to follow: “What is your understanding of the situation and potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?”

The patients’ answers to these questions help clarify their thinking and decision-making. But more importantly, they place the ultimate choice squarely in their hands, and not in those of the doctors. That’s because doctors have been programmed to do all they can to preserve and prolong life, to hold off death until the last possible moment, regardless of the collateral damage to the patient and family. Perhaps equally detrimental is that the patient’s and the family’s final memories are often befogged by a harsh environment of fluorescent lights, plastic tubes, morphine drips, and beeping monitors.

The life force is a powerful thing. I can remember when my father, a still strapping man of 85, lay in a hospital as his kidneys and heart slowly failed him. He had lived the good life and fought the good fight, and wanted to hold on for just a little while longer. Finally, when my youngest sister whispered in his ear that it was alright to let go, he breathed his last. He’d come to realize that he’d finally met his match, as we all will someday.

Frank Batavick is a graduate of Gloucester Catholic (‘63) and La Salle University ('67) with over 40 years of experience as a television writer/producer/director for public TV and media companies in IN and NJ.  He has also served as adjunct faculty and visiting professor in Communications at colleges and universities in NY and MD. Frank now lives in MD with his wife Dori (GCHS, ‘63), where he is the vice chair of the Historical Society of Carroll County’s board of trustees, editor of the Carroll History Journal, and a weekly columnist and occasional feature writer for the Carroll County Times.