He first expresses his frustration as a physician with dying patients he cannot fix and as a son whose father in his 70’s was having mounting difficulties. As a result, he conducted research by interviewing over 200 people about their experience with aging or serious illness.
The most fundamental discoveries of this research were two. “First, . . . we have failed to recognize that people have priorities that they need us to serve besides just living longer. Second, the best way to learn these priorities is to ask about them.”
For a physician like himself, he concluded that the most important questions to ask the patient to discover their priorities are these:
- “What is their understanding of their health or condition?”
- “What are their goals if their health worsens?”
- “What are their fears?”
- “What are the trade-offs they are willing to make and not willing to make?”
Gawande then offers the example of one of his patients, a woman in her early 60’s who had battled a rare pelvic cancer, but two years later developed a leukemia-like malignancy caused by her prior cancer treatment that was incurable by established means.
After having a conversation with Gawande about her goals and fears and priorities, she determined that her most important priorities were returning to her home from the hospital and resuming her beloved piano teaching. Making these two things happen “took planning and great expertise.” But it happened for the last six weeks of her life.
Her husband later said, “She was more alive running up to a [piano] lesson and for the days after.” She still had “some things she wanted . . . [her students] to know before she went. It was important to her to be able to say her goodbyes to her dear friends, to give her parting advice to her students.” At her last recital with the children, she had “taken each student away from the crowd to give a personal gift and say a few words.” She gave a book of music to Gawande’s daughter and whispered, “You’re special.” The dying woman made that day “the best possible day” for herself and for her students.
Gawande also reports that physicians need to know and remember that “[p]eople want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world. These moments are among life’s most important, for both the dying and those left behind.”
Thank you, Dr. Gawande, for this important reminder to us all. I look forward to reading your new book, Being Mortal: Medicine and What Matters in the End, which sounds like a continuation and elaboration of your New York Times article.