Back home from a sad week in Alabama

Buried my Mother in Law on Thursday, after a wild, relatively rare northern Alabama snowstorm on Wednesday. Above, one of Marguerite's birdhouses, out in the back yard by the old feedlot. We got about five inches. It didn't stick long, though, and the funeral service went off OK on Thursday.

Three of the six Prince kids live in northern Alabama close to the homeplace, and they have done the bulk of the home care heavy lifting. Thank you, Beth, Marvin, and Rick. It has not been easy. We appreciate your devotion.

Last of the four parents has now left this life. My Father in Law died at home in January 2010, my Dad in 2008 (after seven dementia-addled years in long-term care), and my Mom in 2011 (four years in LTC after two years in assisted living).

I've started reading Atul Gawande's new book "Being Mortal."

Dependence

It is not death that the very old tell me they fear. It is what happens short of death— losing their hearing, their memory, their best friends, their way of life. As Felix put it to me, “Old age is a continuous series of losses.”

Philip Roth put it more bitterly in his novel Everyman: “Old age is not a battle. Old age is a massacre.” With luck and fastidiousness— eating well, exercising, keeping our blood pressure under control, getting medical help when we need it— people can often live and manage a very long time. But eventually the losses accumulate to the point where life’s daily requirements become more than we can physically or mentally manage on our own. As fewer of us are struck dead out of the blue, most of us will spend significant periods of our lives too reduced and debilitated to live independently.

We do not like to think about this eventuality. As a result, most of us are unprepared for it. We rarely pay more than glancing attention to how we will live when we need help until it’s too late to do much about it...

Gawande, Atul (2014-10-07). Being Mortal: Medicine and What Matters in the End (p. 55). Henry Holt and Co.. Kindle Edition.

Epilogue
Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be.

We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being . And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its 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 field of palliative care emerged over recent decades to bring this kind of thinking to the care of dying patients. And the specialty is advancing, bringing the same approach to other seriously ill patients , whether dying or not. This is cause for encouragement. But it is not cause for celebration. That will be warranted only when all clinicians apply such thinking to every person they touch. No separate specialty required.

If to be human is to be limited, then the role of caring professions and institutions— from surgeons to nursing homes— ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.

I never expected that among the most meaningful experiences I’d have as a doctor— and, really, as a human being— would come from helping others deal with what medicine cannot do as well as what it can. But it’s proved true, whether with a patient like Jewel Douglass, a friend like Peg Bachelder, or someone I loved as much as my father. [ibid, pp. 259-260]

"The family tree will always grow..."

Below, my wife with her six week old grandnephew Camden at the church basement cafeteria meal gathering following the burial.

My Mother in Law got to see him and hold him a couple of days before she died.

I've learned this song for my acoustic book.

Haven't given much thought to the whole Health IT and Health Policy fray this past week. Just glad I got home with no TSA mess over the latest government shutdown standoff.

SCOTUS holds Oral Argument on "ObamaCare" this week (the specious King v Burwell case). Good new stuff over at EHR Science, THCB, and Margalit's On Health Care Technology blog.
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More to come...