“the importance of recognizing one’s own mortality”
We recently surprised my mother-in-law, Shoba, for her 70th birthday by arranging an all-inclusive vacation to Mexico for the whole family. She is a traveler at heart and always has big ideas for what we will do with our time together. She began planning immediately. “Okay, Sara,” she began as she always does when she is explaining something important that she’d like me to do. “I’ve bought this book. You have to read it and then we are all going to have a book club in Mexico to discuss it!” The book was “Being Mortal: Medicine and What Matters in the End” by Atul Gawande. The family was going to a tropical paradise to celebrate life and have a book club about death. More specifically, Shoba wanted the people who were her potential end-of-life caregivers to discuss how she envisioned dying with dignity. It was an odd subject for Mexico, to be sure, but as an estate planning attorney, the subject of planning for death was not unfamiliar to me. Still, I wondered how the discussion would fit in amidst the fruity drinks, shell-collecting and swimming.
Upon finishing the book, however, I experienced a sense of urgency about discussing it with my husband’s family, my own family and, generally, anyone who would listen. My work in estate planning involves helping people have hard conversations about relationships, life and its definitiveness. I truly believe the discomfort of considering incapacitating illness and death can be replaced, to some degree, by the feeling of peace when one entrusts her wishes to those who will be in control at the impending moment. As the title of this book indicates, the writer sets out on a similar mission by punctuating the importance of recognizing one’s own mortality but goes several steps further and urges the reader to think about how they want to experience their final moments. Written by a doctor, the point of view is decidedly medical and extrapolates on the misguided direction medicine has taken in the United States. The author opines that, rather than simply keeping patients safe and alive as long as possible, the goal should be to make each day a patient’s best day. The theory models that of the developing approach of hospice care and focuses on enabling a person, to the extent that it is possible, shape their own story.
However focused on the medical industry “Being Mortal” might be, I found Gawande’s experiences illustrative of my own vocational objectives as an attorney. His stories indirectly underscore the importance of establishing legal documents such as Medical Powers of Authority, Living Wills and Advance Directives. But just as important as these documents are the conversations that bring them about. The conversations that are had in considering the answers to the tough questions become invaluable and even benevolent where they remove the burden of writing the end of a loved one’s story for them with uncertainty.
“I am leery of suggesting the idea that endings are controllable. No one ever really has control… But the point is that we are not helpless either. Courage is the strength to recognize both realities.” -Atul Gawande
So, as we sat around the dinner table one evening, watching the sun dip below the horizon in Mexico, we began the conversation. There was discomfort and a hushing of talk when one of the grandkids wandered near, but in Shoba’s voice I heard immediate relief. She expressed the importance she placed on quality of life over quantity. She emphasized her desire to avoid suffering at all costs and the hope that this would alleviate any feeling of burden she might place upon us kids. Later, I spoke with her and my father-in-law about the details she could provide in legal documents to help communicate the specifics of their wishes in the case of incapacitation or end-of-life treatments. And a few days later, we all hugged and kissed and said our goodbyes. Time still continues to slip by and we all grow older, but during our time together, our family had the courage to be present and aware of our mortality long enough to have the tough conversation and as we departed paradise, we did so with peace of mind.