‘Thou shalt not kill; but needst not strive
Officiously to keep alive…’
Arthur Hugh Clough had it poetically straight in the early 19th century, but with modern medicine we now sometimes expect miracles at the end of a scalpel or the syringe injection of a new drug.
But surgeon and medical writer Atul Gawande questions if we are asking patients the right questions to discover what outcomes they wish for; his own father when faced with problems said a good quality of life would be being able to sit around the dining table, eating and conversing with friends.
Gawande thinks it is important that the right questions are asked about end of life care, he told a packed three tier audience in the ASB Theatre in discussion with ICU specialist David Galler.
An important anecdote: when one group of prospective knee replacement candidates had discussion with their doctors only about the medical procedure, most chose to go ahead. But when a similar group were given the same information and were also asked about the outcomes they wanted from surgery, fewer opted to go ahead.
A highlight was the tale of a zoo let loose in the residential nursing home. Plants and pets are part of most homes, so it was argued why not in residential care? Great plan, but having a large number of parakeets delivered before cages were constructed caused temporary chaos. However long term results saw happier, more engaged residents taking dogs for walks, cuddling cats and feeding the birds… as well as becoming more active, more engaged and needing dramatically fewer medications.
Gawande writes incredibly well – as a medical columnist for the New Yorker his apprenticeship under a tough editor the many rewrites he was asked to make, see his literary skills matching medical ones.
A postscript discussion by the two doctors talked about the surgical theatre check list system initiated at the Boston hospital where Gawande works which is now used internationally in many hospitals,including Middlemore, where Galler is based.
Reviewed by Jillian Ewart