I’m one of those guys who would like to go to heaven but I’m not willing to die to get there. So reading Atul Gawande’s “Being Mortal” was not easy for me.

Dr. Gawande gives a medical doctor’s view of my parents’ teaching. In his words, we should, “Live as long and as well as you can and accept that mortality is universal.”

My MD/Surgeon Dad told us that “extraordinary measures” were unnecessary. My Mom simply taught us growing old gracefully. Mom didn’t want to live beyond her useful life. Dad’s view was similar to Dr. Gawande’s: Take appropriate measures to live well but also realize there is a time to give in to the inevitable.

Amazing advances in medicine have altered our target from living better, quality lives to living longer via radical protocols and surgeries near the end of our lives. More than half of our lifetime medical cost occurs in the last 12 months of our lives. Gawande’s most starting finding though is that this approach tends to decrease the length and quality of lives versus extending them. (Massachusetts General Hospital Study, 2010)

Shortly before my Mom’s 90th birthday, she called each of her children and asked, “May I die now?”

Mom’s case was that at 87, she was told she needed dialysis for her failing kidneys. When given her “sentence” (her words), she called her children to tell them she wasn’t very happy about doing dialysis as she considered it an “extraordinary measure.” She'd been through other life-extending protocols which made sense to her but this seemed too much to her. After talks with us and her doctor and her priest, she reluctantly chose to do it. She used the two years she gained well since her children and grandchildren visited her frequently and we helped her write a book about her life that we still treasure.

But during this time she also told me that her 2x a week dialysis protocol gave her only one quality day a week. (Two days in the shop and two days each time to recover) “This isn’t that great a way to live, Timmy.” So, about a year and a half into dialysis, she made the call that is this blog’s title. Her children and grandchildren then surrounded her during her peaceful last days.

Mom was not “against” dialysis given different circumstances. But as with Dr. Gawande and his concept of “being mortal”, her objective was to live well and fully. By letting go of a treatment that exhausted her physically and financially she resisted what the book calls “allowing our fates to be turned over to the imperatives of medicine, technology and strangers.”

Much of Dr. Gawande’s book is stories, including that of his own father and many patients. Some stories are of rescue missions that ended unhappily and others are of medical people he admires for their caring, life quality enhancing treatment of older and terminal patients.

Gawande's theory could include the Serenity Prayer: "God grant me the serenity to accept what I cannot change, the courage to change what I can and the wisdom to know the difference."

When my fate is in question, as inevitably it will be, I’m hopeful I will remember that prayer.

Peace,

Tim McCarthy