Atul Gawande

October 6, 2014 - Atul Gawande 10/06/2014 Views: 53,997

Dr. Atul Gawande endeavors to start a compassionate and well-reasoned dialogue about the end of life with his book "Being Mortal: Medicine and What Matters in the End." (7:26)

(CHEERS AND APPLAUSE)>> Jon: WELCOME BACK, MY

GUEST BEST SELLING AUTHORAND A SURGEON AND A PROFESSOR AT

HARVARD MEDICAL SCHOOL, HISNEW BOOK IS CALLED, "BEING

MORTAL, MEDICINE AND WHATMATTERS IN THE END."

PLEASE WELCOME BACK TO THEPROGRAM, ATUL GAWANDE.

(APPLAUSE)(APPLAUSE)

HELLO, SIR. NICE TO SEE YOU.

THANK YOU SO MUCH FOR BEINGHERE.

THIS IS, BEING MORTAL, IT ISA REALLY, YOU KNOW, IT'S THE

KIND OF DISCUSSION THAT WEDO NOT HAVE IN THIS COUNTRY,

IT IS A REASONED DISCUSSIONABOUT THE END OF LIFE.

AND WHAT MATTERS TO PEOPLE.

IN THIS COUNTRY, ALL THEPANIC OF DEATH PANELS AND

ALL THESE THINGS.

HOW SHOULD WE START THISCONVERSATION?

>> SO, I STARTED ASKING THAT,17% OF OUR COUNTRY AT THE

END OF THE '90s DIED ATHOME.

AND THE REST WERE ININSTITUTIONS.

AND THAT'S NOT THE WAY MOSTPEOPLE WANT TO GO.

AND SO WHAT I WAS WONDERINGABOUT WERE THE PEOPLE WHO

HAD IT GO BETTER THAN YOUEXPECT, AND AT THE CENTER OF IT

WERE CONVERSATIONS ABOUT, YOUKNOW, SIMPLE THINGS.

WE DON'T ASK WHAT THEPRIORITIES PEOPLE HAVE IN

THEIR LIFE, BESIDES JUSTLIVING LONGER.

WHAT ARE THE TRADE-OFFSYOU'RE WILLING TO MAKE, AND

NOT WILLING TO MAKE.

WHAT ARE FEARS AND GOALS YOUMIGHT HAVE.

WHAT WORRIES DO YOU HAVE FORTHE FUTURE.

AND IF WE ASK THAT, ASDOCTORS, YOU START GETTING

SOME REAL GUIDEPOSTS TO WHATPEOPLE CAN ACHIEVE IN THEIR

LIVES. EVEN WHEN IT'S SHORT.

>> Jon: BECAUSE THERE IS --THERE'S A SENSE IN AMERICA THAT

NO MATTER WHAT, I DON'T CAREWHAT HAPPENS, I DON'T CARE WHAT

CONDITION I'M IN, YOU DO WHATYOU CAN, CUT OFF MY HEAD,

PUT IT IN A JAR, HOOK IT UPTO A BATTERY, WHATEVER YOU

NEED TO DO, YOU MUST DOTHIS.

AND THAT'S NOT AS YOU STARTTO SEE, YOU KNOW, AND GOING

THROUGH THIS WITH PARENTS THATARE GETTING OLDER,

YOU START TO REALIZE, WELL,MAYBE THIS ISN'T ABOUT JUST

DO WHATEVER YOU CAN.

>> I MEAN I WROTE THE BOOKIN PART BECAUSE I'M A CANCER

SURGEON.

AND I DIDN'T FEEL LIKE IHANDLED THESE VERY WELL.

AND THEN MY DAD GOT A TUMOR INHIS BRAIN STEM AND HIS

SPINAL CHORD.

AND WE DIDN'T WANT THATPATHWAY TO THE END.

WE WANTED HIM TO GET ALL THESURGERY, ALL THE RADIATION,

ALL THE CHEMOTHERAPY, BUTNOT AT THE COST OF WHAT HE

THOUGHT A LIFE WAS WORTHLIVING FOR.

HE WANTED TO STILL BE WHO HEWAS.

AND WE HAD THESE HARDCONVERSATIONS THAT I LEARNED

FROM WATCHING HOW PEOPLEHANDLE THESE BETTER THAN I

DID AND THOSE KIND OFCONVERSATIONS WERE JUST A

FEW BASIC QUESTIONS.

I WOULD ASK MY DAD.

SO WHAT IS YOURUNDERSTANDING OF YOUR

CONDITION NOW?

HOW IS IT GOING?

AND HE WOULD SAY IT'S NOT GOINGTHAT WELL.

I'M CONCERNED.

I'M LOSING MY ABILITY TOWALK NOW.

>> Jon RIGHT.>> WE WOULD SAY, YOU KNOW,

WHAT ARE YOUR, WHAT ARE YOURFEARS AND GOALS?

>> AND HE WOULD SAY WELL, ASLONG AS I CAN ACTUALLY

INTERACT WITH OTHER PEOPLE,AS LONG AS I CAN STILL

CONTRIBUTE, YOU KNOW, HEWAS STILL WANTING TO DO CHARITY

WORK AND WORK FOR ROTARYFOUNDATION WAS IMPORTANT TO

HIM IN HIS LAST FEW MONTHSOF LIFE.

HE STILL DID IT.

>> Jon: RIGHT.

>> AND WE CAN MAKE THATCHOICE ALONG THE WAY.

WE DID SURGERY BECAUSE ITLET HIM DO THOSE THINGS MORE.

WE DID RADIATION, BUT WHENTHE CHEMOTHERAPY TOOK IT

AWAY, THAT'S WHEN WE STOPPEDIT.

>> Jon: RIGHT.

AND THESE, SOME OF THESEAGGRESSIVE TREATMENTS, PEOPLE

MAYBE DON'T REALIZE THE EFFECTTHAT IT MIGHT HAVE ON THEIR

SIMPLE QUALITY OF LIFE.

AND THE AMAZING THING TO MEIS, THESE MORE PALLIATIVE OR

HOSPICE TYPE REMEDIES,PEOPLE TENDED TO LIVE

LONGER.

>> YEAH, THERE'S AN AMAZINGSERIES OF STUDIES NOW THAT HAVE

SHOWN, ONE EXAMPLE, ATTHE MASS GENERAL HOSPITAL

IN BOSTON, THEY RANDOMIZEDHALF OF THE PATIENTS WHO HAD

LUNG CANCER, STAGE 4, LIVED ONLY11 MONTHS ON AVERAGE, TO GETTING

USUAL ONCOLOGY CARE VERSUSUSUAL ONCOLOGY CARE PLUS

SEEING A PALLIATIVE CARESPECIALIST WHO HAD

CONVERSATIONS WITH THEM ABOUTWHO THEIR GOALS MIGHT FEBRUARY

THEIR HEALTH WAS THERE SO ONESHAD THE CONVERSATIONS WITH THEM

ABOUT WHAT THEIR GOALS MIGHT BEIF THEIR HEALTH WORSENED.

>> THE ONES WHO HAD THECONVERSATIONS ENDED UP HAVING,

THEY HAD CHOSE FEWER DAYS IN THEHOSPITAL, THEY STOPPED

CHEMOTHERAPY SOONER. THEYWENT ON HOSPICE EARLIER.

THEY HAD LESS SUFFERING ATTHE END OF LIFE AND THEY

LIVED 25% LONGER.

THAT JUST MEANS WE'RE MAKINGBAD DECISIONS ALONG THE WAY,

OUT OF OUR ANXIETY ABOUTHAVING THESE CONVERSATIONS.

>> IS THERE ANYTHING MORENEFARIOUS OTHER THAN

ANXIETY?

IS THERE SORT OF APHARMACEUTICAL INDUSTRIAL

MEDICAL COMPLEX THAT IS SOSTEEPED IN PROCEDURES, AND

THE FINANCE THAT GOES ALONGWITH IT THAT IT'S GOING TO

BE HARD TO BREAK THROUGHTHAT AS WELL?

>> YEAH. EVERY PUSH IN OURSYSTEM IS TOWARDS DO SOMETHING

MORE.

YOU KNOW, I GET PAID MORE TODO THE OPERATION BY FAR

THAN I WILL EVER GET PAID TONOT DO THE OPERATION.

IN FACT, YOU KNOW, WE DON'TMAKE IT EASY FOR PEOPLE TO

HAVE...>> Jon: RIGHT.

>> TO TAKE THE TIME FORTHESE CONVERSATIONS. YOU KNOW,

ON THE OTHER SIDE, THE FAMILIESAND THE PATIENTS, THEY CAN FIND

IT HARD TO ACKNOWLEDGE THAT WESHOULD BE THINKING ABOUT THE

WORST-CASE SCENARIO AS WELLAS THE BEST-CASE SCENARIO.

>> Jon: RIGHT.>> YOU KNOW, LET'S,

LET'S GO FOR THE LOTTERYTICKET BUT ALSO PLAN FOR

WHAT HAPPENS IF THE LOTTERYTICKET DOESN'T COME THROUGH.

>> AND I THINK THE GOOD NEWSFOR SOME OF THIS IS BECAUSE

OF EBOLA, WE'RE ALL GOING TODIE SOON ANYWAY.

(LAUGHTER) SO IN MANY WAYS,

WHILE THIS IS AN INCREDIBLYHEARTFELT AND WELL REASONED

BOOK, TWO WEEKS FROM NOW...(LAUGHTER)

ARE WE ALL GOING TO DIE, BY THEWAY? BECAUSE YOU ARE A SURGEON.

YOU UNDERSTAND, YOU HAVE WRITTENARTICLES ABOUT EBOLA.

ABOUT HOW WE HANDLE THINGS.

ARE WE ALL GOING TO DIEIMMEDIATELY OR DO WE HAVE

LIKE A MONTH.

>> WE ARE NOT IN DANGER OFTHIS BEING AN EPIDEMIC

SPREADING THROUGH OURPOPULATION HERE.

>> Jon: DO YOU WATCH THE NEWS?

SLIGHTLY DIFFERENT TAKEON IT.

YOU'RE COMING FROM A REASONEDMEDICAL PROFESSION TAKE,

THEY'RE NOT GOING WITHTHAT.

ARE WE WELL SET UP TO HANDLETHESE TYPES OF THINGS?

>> SO ON ONE LEVEL, LOOK, WEHAVE SOME BASIC INFECTION

CONTROL PRACTICES THAT WE'RENOT GOOD ENOUGH AT IN THIS

COUNTRY.>> Jon: RIGHT.

>> WE HAVE 2 MILLION PEOPLE WHOPICK UP INFECTIONS IN OUR

HOSPITALS. AND THERE ARE, ANDYOU KNOW, MY LAST BOOK,

"THE CHECKLIST MANIFESTO" WASABOUT THE IDEA WE AREN'T

EVEN FOLLOWING THE CHECKLISTS...>> Jon: YES. YES.

>> ABOUT WHAT WE CAN DO.

THE REAL CONCERN IS THAT BYMAKING IT, WELL, SO THE RED

LIGHT HAS TURNED ON, ANDSUDDENLY HOSPITALS ARE

LEARNING OH MY GOD, WEBETTER BE WASHING OUR HANDS.

>> Jon: RIGHT.

>> AND WE BETTER PUT ON THEGOWNS PROPERLY AND WE BETTER

TAKE THEM OFF PROPERLY.

AND THAT'S PROBABLY A REALLYGOOD THING FOR US.

IT'S AMAZING.

>> Jon: BEFORE EBOLA SURGEONSCOME IN THERE WERE LIKE GRASS

STAINS AND LIKE RIB JUICE.>> YEAH.

>> Jon: I DON'T KNOW WHAT THEHELL IS GOING ON.

BUT HERE'S-- I LOVE YOURAPPROACH ABOUT IT, AND

"CHECKLIST MANIFESTO"WAS THE SAME WAY.

IT JUST, IT IS DISPASSIONATEBUT COMPASSIONATE IF THAT

MAKES SENSE.

IT'S VERY REASONED BUT WITHCOMPASSIONATE ITS CORE.

AND IT STRIKES ME AS THE WAYFORWARD FOR ALL OF THIS.

>> WELL, I LIKE BEING HEREWHEN YOU SAY THAT.

>> Jon: WELL, THERE THEN,YOU ARE.

AND THAT'S HOW IT GOES.

BUT THIS IS INCREDIBLE.

AND I HOPE AS IT WAS WITHCHECKLIST THAT IT BEGINS

A CONVERSATION THATIS SO NECESSARY.

I MEAN WE'RE ALL, OURPOPULATION IS GETTING SO

MUCH OLDER NOW.

AND IT WOULD BE SO MUCH BETTERFOR THEM TO HAVE ACCESS TO THIS

TYPE OF CARE.

>> FOR ALL OF US.

>> Jon: FOR ALL OF US WOULD BEGREAT.

"BEING MORTAL," IT'S ON THE BOOKSHELVES NOW.

IT'S REALLY TERRIFIC.

ATUL GAWANDE, THANKS SO MUCH FORCOMING BY.