This is the third book that Shu and Renshi has read for you, "The Best Farewell: Common Sense You Must Know About Aging and Death"
Life is a one-way street.
From the moment we are born, we progress step by step towards decline and death. Although the continuous improvement of medical technology can delay the occurrence of our death, it is undeniable that medicine still has limitations - although we can help patients overcome difficulties through pills, injections, surgeries, and intensive care units, we cannot make patients overcome their difficulties. Their lives have returned to their previous baseline, and even a minor cold may cost them their lives.
Facing the last test question in life, some people are afraid, depressed, sad, and anxious all day long, while some people are positive, optimistic, open-minded, and live a wonderful life.
So, given the limitations of medicine and the inevitability of death, how should we make our old age decent and comfortable? What help can modern medicine and society provide for our elderly care and treatment?
The book "The Best Goodbye" is written by Atul Gawande, a rare medical wizard. Born into a medical family, he is currently a professor of surgery at Harvard Medical School, director of the World Health Organization (WHO) Global Patient Safety Challenge Project, and an advisor on health care reform to the two Democratic administrations of Clinton and Obama.
In this book, he focuses on human aging and the approach and response to death. Based on more than ten years of professional experience, he tells us how to enrich our lives at the end of our lives and live to the end of our lives with independence, happiness and dignity.
Now, let us open this insightful book together and explore the mysteries of life and death with Dr. Atul Gawande!
With the continuous improvement of living standards and the continuous advancement of medical technology, longevity is no longer a scarce resource.
However, on the one hand, the development of information and communication technology means that the elderly no longer have exclusive control of knowledge and wisdom. Once upon a time, we would ask an old-timer for advice on how to understand the world, but now we go directly to the Internet to look it up.
On the other hand, increased lifespan has changed the relationship between the elderly and the young. In the era of industrialization, the elderly began to break through the limitations of "raising children to provide for old age" and rely on the wealth accumulated before retirement to financially arrange their own life in old age. At the same time, the elderly have begun to pursue a free, independent, and self-help lifestyle. They no longer regard their children's travel as a form of unfilial piety, but instead regard it as a kind of "intimacy at a distance."
However, there is also a problem with this lifestyle: What should we do when serious old-age diseases or aging come, and when an independent and self-help life can no longer be maintained?
In the book, the author tells the story of her wife's grandmother, Alice Hobson. The old lady was 77 years old at the time. She was enthusiastic and independent-minded and never tried to hide her age. Her hands were covered with age spots and her skin was wrinkled. She was wearing a simple but neatly ironed shirt and skirt, and a little lipstick on her lips.
She has lived alone in her old house in Arlington since her husband Rich died of a heart attack. She mows her own lawn, fixes plumbing, goes to the gym with friends, and drives to concerts. She loved to sew and knit, and she would knit red and green Christmas socks for each family member, with Santa Claus and her family's names embroidered on the stockings. She also ran errands, visited family, drove friends, and helped others who were sicker than she was.
The good times did not last long. When she was 84 years old, she fell at home. Her physical decline spread like a vine, her steps became unsteady, her memory deteriorated, her disability became more and more severe, and her dementia became more and more serious. For this reason, she had to give up living alone, accept the doctor's advice, and live with her daughter and son-in-law.
Aging is our destiny, and death will come one day. Although medical advances can delay the time when health conditions push them to the ski slopes, they cannot change the trajectory of life's disappearance.
Buddha said: "There are eight sufferings in life: birth, old age, illness and death, resentment and hatred, love and separation, not being able to seek, and not being able to let go."
The impermanence of life and the pursuit of perfection have always troubled us. Amid all kinds of uncertainties, only by accepting the complexity and limitations of medicine and respecting the laws of life can we overcome pain and move towards the nirvana of life.
"Old age is not a battle, but a slaughter."
In the novel "Everyman" (Everyman), the writer Philip Rohn wrote bitterly.
As we age, our bones and teeth begin to soften, and our blood vessels, joints, heart valves and even lungs become hardened due to the absorption of large amounts of calcium deposits. Our hearts begin to experience greater stress, while muscle mass and strength elsewhere diminish. Our brains begin to shrink, and our memory and decision-making abilities begin to decline. Our vision begins to blur, our hearing begins to deteriorate, and we no longer speak fluently.
Though with luck and strict self-control, we can maintain our lifestyle for a long time. But eventually all losses reach a breaking point, when we lose the ability to cope with life on our own.
"Oh, I'm old, I'm old."
In this lifetime of sighs, we hear not only the helplessness of the old man about his physical condition not being as good as before, There is also the worry among the elderly about the loss of personal value.
In 1943, psychologist Abraham Maslow published his influential book "A Theory of Human Motivation", which famously proposed the hierarchy of human needs, that is, when we can eat After we are well fed and clothed, we begin to pursue a reason beyond ourselves. This reason can be big (family, society, principles) or small (reading a book, completing a trip, taking care of a pet).
The important thing is that this reason gives our lives meaning and supports us through the many hardships in life until we break out of the cocoon and become a butterfly, Nirvana and rebirth.
Our hierarchy of needs changes as we age.
In early adulthood, we seek new experiences, wider social connections, and leaving our mark around the world. As we age, our horizons begin to shrink, and our focus gradually begins to shift to the here and now, to daily life and the people closest to us.
Although our priority needs may vary at different stages of life, our pursuit of the meaning of life is eternal.
We need a home of our own. At home, we can decide how to organize our time, how to share space, and how to take care of our belongings.
However, the development of facts is contrary to our expectations.
On the one hand, we want to retain our autonomy or freedom as a chapter of our own lives, to live the life we ??want to live, rather than being driven by it.
On the other hand, we worry about the people we love.
"If you hold it in your mouth, you're afraid of melting, and if you hold it in your hand, you're afraid of falling." We take care of our parents like we take care of children. We bring them in to live with us, Buy groceries with them, chat with them to relieve their boredom, take them on trips, etc. But we forget to ask them if they want to.
"Betrayal of body and soul that threatens our identity and memory is the most terrible torture. The battle to be human is the battle to preserve the integrity of life - to avoid being diminished, dissipated, conquered, To avoid being separated from your past self and who you want to be in the future."
In the 1980s, in order to fulfill my mother's wish - to have a small house with my own life in it. Likes having someone who can help her do things she can't do on her own, but won't be interested in turning off soap operas she wants to watch, throwing out her collection, or making her attend activities she doesn't want to attend, Karen Brown Wilson first proposed the concept of "assisted living" and established the first assisted living area for the elderly in Oregon with her husband, aiming to create a place for the elderly to live freely and autonomously, no matter how poor their physical condition is.
This 112-unit home was filled with tenants almost instantly. They have private apartments with full bathrooms and kitchens, and they can keep pets and decorate their own rooms. When they need help, they can ring a bell to call a 24-hour nurse. They can continue to participate in activities they value and stay connected to the outside world.
After 15 years of follow-up surveys, the residents’ health, cognitive abilities, physical functions and life satisfaction have improved significantly. When they talk about their lives, their faces are filled with happy smiles. Although they know that aging and death are inevitable, they are no longer sad or afraid, because their spiritual world is happy and rich.
The great success of assisted living reflects people’s pursuit of autonomy in life when they are old, frail, and no longer able to take care of themselves.
So, what can our medicine do for us when aging and disease come?
"Death and life have their limits, but life is impermanent."
In my opinion, the significance of medicine is not only to help patients relieve pain and save lives, but also to help patients improve their lives. quality to help them reach the end of their lives with dignity.
This also raises a difficult question: "When should we work hard to treat, and when should we give up treatment?"
Douban's high-scoring movie "Me Before You" tells us It tells a cliché but sad love story.
The male protagonist was once heroic and had a bright future, but he lost the courage to stand up due to an unexpected car accident. The heroine is a kind and cheerful small town girl. Her whole family is in crisis of unemployment. Because of the good salary, she chooses to become the hero's caregiver.
As a high-level paraplegic, his days are like years. For him, euthanasia seems to be the best choice.
After hearing the news, she began to do her best to reawaken his passion for life. She took him to watch horse races; she and he dressed up to attend parties and danced with him; she accompanied him to see the stars and the moon, and talked about everything from poetry and songs to the philosophy of life.
"There are many kinds of encounters in life, and love is a fate that cannot be escaped.
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Her sunshine and love dispelled the gloom in his heart and became his only nostalgia for the world. However, the pain of living has exceeded the happiness, and he does not want to drag down the heroine's life.
"You are the only reason why I wake up every morning." He left a letter and walked to the end of his life with a smile accompanied by her and her parents.
He is unfortunate. When he is high-spirited, he encounters unexpected disasters, accompanied by pain. But he was also lucky. In the last six months of his life, he saw the most sincere love in the world and saw his beloved her financial situation improve with his help.
Love is not letting go, but also understanding and respect.
When life comes to an end, dying patients need not only to reduce pain, but also to receive meticulous care and attention - just like nurses in assisted living to help the severely disabled. Way.
"There is a time to live and a time to die." Accepting one's own mortality and clearly understanding the limitations and possibilities of medicine is a sign of respect for life.
So, when the end is approaching, how should we discuss treatment options with our doctors so that we can relieve pain while maintaining dignity and meaningful life?
In the book, the author explains three doctor-patient relationships for us through the example of whether to take red pills or blue pills.
The first type of relationship is called a "parental" relationship. Doctors, as medical authorities, aim to ensure that patients receive the treatment they believe is best. They will tell you, "Take the red pill, it's good for you." They may or may not explain to you what the blue pill does. Although this model of doctor-patient interaction is often criticized, it is the most common model of doctor-patient interaction for patients who are vulnerable to injury and those who are easy to follow orders.
The second kind of relationship is called "information type" relationship. The opposite of a paternalistic relationship, where the doctor tells the patient the facts and figures, and the patient takes care of everything else. "This is what the red pill does, this is what the blue pill does, which one do you want?" This is a retail-type relationship. The doctor's job is to provide the latest knowledge and technology, and the patient's task is to make the decision. . Although patients have more autonomy, they bear the risk of treatment failure.
The third type of relationship is the "explanatory" relationship that the author recommends most. The doctor is patient-centered, fully understands their goals and desires, and helps them make the best choice. They will first ask the patient, "What is important to you? What worries you?". After getting the answer, they explain to the patient what the red and blue pills do and help them make a decision.
The "explanatory" relationship not only respects the patient's wishes, but also demonstrates the doctor's professional knowledge and skills. It is not only correct, but also necessary. It embodies the modern medicine's care for the patient. Respect and reverence for life.
Human life is a kind of practice. Although the flowers and willows in this world are blooming, the struggle and resistance in the death process and the confusion about the afterlife have always been inevitable entanglements in life. But no matter how entangled we are, we must bravely cross that threshold and travel far away.
Let us be brave enough to love and live bravely, because life never waits!
Throughout the book, the author discusses end-of-life medical care, nursing and elderly care through real stories. Through each case provided by the author, I saw not only the good and adequate medical care that Americans enjoy, and the humanistic care from doctors in their interactions with doctors, but also the psychological needs and emotions of dying patients and the elderly. Insufficient understanding and care of their needs often leads them to provide wrong treatment options and false hope, leaving them to die in pain.
"Sometimes heals, often helps, always comforts" seems to express the true meaning of medical treatment itself.
I sincerely hope that when you look back on this life, you will feel treated well, warmed and loved.
*Note: The pictures are from the Internet