Atul Gawande on matters of life, death and medicine

Death never makes for a good conversation. So we mostly avoid talking about it. In an in-depth and profound talk on the fatality of this silence, Atul Gawande, reputed surgeon, writer and Harvard professor, questioned the default setting in our minds for an unqualified desire to survive at all costs in the age of modern medicine.

Deftly handling a difficult subject with a touching sensitivity, Gawande sought to reconcile the audience to its own mortality, and answer the fundamental questions that it raises.

Seeking to introduce a new paradigm of doctor-patient relationships, Gawande argued that with changing patterns of death, where growing old is far more common, it is essential for medicine to offer the opportunity to not just live longer, but instead live happier.

Gawande confronted these difficult questions by searching for these answers in his own experiences as a doctor and a son caring for his ailing parents. The solution, according to Gawande, is to be found in language - in a doctor's ability to listen to the patient's needs, in not assuming or avoiding how one will deal with their death or in living their final years.

Here are the main takeaways from the session:

1. Gawande talked about how doctors are programmed to be heroes who fight mortality and don't accept it easily. He felt that he sometimes avoided uncomfortable discussions on death with terminal or chronically-ill patients. For Gawande, survival had gotten so deeply institutionalised in modern medicine that the kind of life that survival would offer was often ignored.

2. The author argues that modern medicine often made doctors suggest treatment plans with almost no scope for success to their patients. While the doctor was programmed to offer a long but bleak survival, the patient was expected to be heroic by persisting to achieve this end.

3. He drew from his own life to talk about how his father, being diagnosed with an incurable brain tumour, forced them to look at death differently. On realising that he had lesser time than he had thought, his father managed to set his priorities straight and live his last months in the way that he desired.

4. In a poignant moment of the session, Gawande spoke of the "crisis moment" in families when one realises the inability of the elders to take care of themselves. He remembered the time when his parents who lived alone fell down at night and were unable to get up. They had to pull a blanket over themselves as they lay on the floor till a neighbour came and helped them. It was these crucial moments that are being ignored by medical care today.

5. Gawande stressed on the need to improve the quality of healthcare for the elderly in the contemporary absence of the kind of family structure that had cared for his 108-year-old grandfather. He argued for the essential need of medicine to focus on hospice care as much as hospital treatments. Hospice care offers a way to live one's best day today, regardless of what that means for tomorrow.

6. Gawande said that wellbeing is "bigger than just how long the heart pulses and the lungs breathe". It is a measure of happiness. Offering a shorter but more content life was not antithetical to medicine. Rather, in the modern age, it was the most pressing prerogative of medicine.

7. He concluded by talking about being called an "explainaholic" doctor. A doctor must provide medical solutions for patients based on their willingness to sacrifice the present for the hope of a future. The words used by the doctor are essential in reassuring the patient that there is no objective way to approach death, even if modern medical discourse would suggest otherwise.