Artificially Prolonging Life: The Gawande Condundrum

Shadow on his window sill

Shadow on his window sill

Have you read Being Mortal by Atul Gawande?

If not, you should! Everyone should. This remarkable book describes how dying has become medicalized.

It used to be that people got sick and died. They were killed by influenza and TB and heat attacks, cancer and strokes. These things happened to them and, well, they just died.

But now, someone has a stroke or a heart attack or cancer and off to the doctor they go to be cured. Or, if not to be cured, to have their lives extended and extended and, sometimes, extended.

Dr. Gawande, in his beautifully written and thoughtful book examines the complicated relationship between medicine and dying or, more accurately, prolonging life.

Our Kitty, Shadow, is Dying

Shortly after I finished the book, my lovely 16 year old white cat, Shadow, showed signs of not being well. His voracious appetite waned. He stopped knocking things off my desk when he wanted attention. Instead, he started hiding behind the couch and looking tired.

X-Ray of Shadow's heart and lungs

X-Ray of Shadow’s heart and lungs

I packed him up in the little kitty carrier and off we went to the vet.

She listened to his heart which was “galloping” and heard his labored breathing. And she suggested that she take some chest x-rays to see what was going on.

Diagnosis: Congestive Heart Failure

Shadow has congestive heart failure. His heart is enlarged and fluid is filling his lungs.

The solution? Pills!

Pills to reduce his fluids and stabilize his heart. Seven pills each day. Three in the morning, four in the afternoon.

Now, if you have a cat, you know they don’t like to take pills. It’s an unseemly invasion to have little tablets rammed down their throats.

But in the hopes of making Shadow more comfortable, I did it. And he rallied for a few days. Until I noticed that he was drinking lots of water had very stinky breath and really didn’t look happier.

What was I doing? Shadow is an old cat. Does he deserve to have me trying to keep him alive?

The Gawande Conundrum

I was face to face what I think of as the Gawande Conundrum.

Is it more important to prolong life or to help make the end comfortable and fulfilling? When is it time to stop treating dying like a curable disease?

Our sweet kitty, Shadow, is dying. The vet says that even with medication he’ll be lucky to live another 3 months. Doesn’t he deserve to die in peace without my ramming pills down his throat that make him thirsty and stress his kidneys?

We’ve decided to stop giving Shadow medication and to let him live out his life in peace.

We’ll make sure he has everything he needs to be comfortable. He’ll have his favorite foods, special treats, warm places to sleep. We’ll give him plenty of petting, and I’m sure that as long as he can, he’ll keep purring.

And when he stops breathing, though we will be very sad, we’ll know that we treated him with the love and respect he deserves right to the very end.

I hope that when I or the people I love are ill, we will have the courage to see dying for what it is, a natural end to life.

TryTry ThisThis

How do you want to die?

It’s not comfortable to think about dying. We don’t want to die. Nor do we want our loved ones, friends, family members or pets to die. But I think it’s wise to consider the matter beforehand so that when you are up against it, you have a sense of what you believe and you’ve made the necessary preparations.

How would you handle Shadow’s illness?

If you have experience with end-of-life decisions, would you share them here? Each and every one of us will face death. Sharing your experiences might help someone else.