In the end, people don’t view their life as merely the average of all its moments—which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens.
-Atul Gawande
All of our lives are stories, long and complex ones,which we don’t always understand, but which we know will one day come to an end. Even knowing that, we as a species tend to either fight against that reality or ignore it altogether. Even those who are most aware of the inevitability of death—doctors—tend to treat it as a failure, and struggle to talk to their patients about its looming reality.
On March 16th, at the Mexican Heritage Plaza Theater in San Jose, Institute on Aging collaborated with the City of San Jose and Santa Clara County Department of Aging and Adult Services, to co-host a screening and discussion of Being Mortal, a Frontline documentary based on Dr. Atul Gawande’s best-selling book about people, families, and doctors dealing with terminal illness and the end of life. A multicultural panel session featuring experts from around the region followed, as over 300 audience members and participants grappled with the how our cultures deal with this mysterious central theme, the one aspect of life that truly binds us all together: the reality of being mortal.
Gawande and the Failure to Be Realistic About Dying
In his book and documentary, Dr. Gawande talks openly about how doctors treat a patient dying as the worst possible outcome, no matter the scenario, and so tend to do whatever they can to stave that off. They do this even if it means prolonging suffering, running up untenable expenses, and reducing the quality of life. Quantity seems to be all that matters.
For Gawande, this is a failure to understand life. He says that doctors—including himself—have difficulties talking to patients and families about death because we see life as a string of moments, which needs to be extended, rather than a story that matters. When we see the arc of our life, we can see that the end isn’t something to be pushed away indefinitely, but is a worthy conclusion to the story.
His film is a moving and deeply serious one, that challenges us to accept death not as the antithesis of life, but as a part of life’s process, and to understand that living in the face of death can bring more meaning to being alive.
Panel Discussion: Death and Culture
Every culture treats death a little differently. Some have more reverence and awe for death as an almost physical presence in their lives, with strong religious connotations, while some try to ignore or sanitize it. There is no correct or incorrect way. It is all about accepting death’s reality.
In the panel discussion that followed, led by the IOA’s own Dr. Patrick Arbore, the founder of the Friendship Line and the Director for Center For Elderly Suicide Prevention and Grief-Related Services, experts from cultural groups around the region provided insight into how the end of life is treated and dealt with in different groups. Our multi-cultural event included representatives from the area’s vibrant and diverse groups, including the Chinese, Hispanic, Indian, Japanese, and Vietnamese cultures. The speakers were:
- Sophie Horiuchi-Forrester, MA Consultant and Former Executive Director of Yu-Ai Kai Japanese American Community Senior Service of San Jose
- Angelica Leon, MSW, Social Worker/Case Manager, Institute on Aging, Santa Clara Region Community Living Connection
- Sulochina Lulla, M.D., MPH, Allergist-Immunologist, Preceptor for Medical Residents of Kaiser Hospital, Santa Clara and for Nursing Students from San Jose University for School Health Nursing and Representative from Pallium India, USA
- Chi Mai, RN, Stanford Healthcare E-2 ICU (Med/Surg/Neuro/Trauma) in Palo Alto, CA and Kaiser Permanente of Santa Clara Stroke Cardiac Telemetry Unit and Research ambassador of the Stanford iSAGE program and the “Letter” project
- Jeanne Wun, Former Manager, Community Engagement & Community Relations of Hospice of the Valley, San Jose, and Past Chair, Board of Directors Chinese American Coalition for Compassionate Care
Understanding our own mortality is not just about accepting death: it is about changing our understanding of life. The film and our panel discussion helped participants see end of life issues in a different way. Medical experts are beginning to come around to the idea that their role as a professional is to make sure that life is filled with quality, and not just with a little bit of extra time.
That’s also the role of groups like Institute on Aging. We want to help older adults live in peace and dignity, to help with depression and grief, and to make life something to be cherished, as well as understood. As part of our continuing series, we will be hosting “Endings Matter: A Conference on End of Life and Palliative Care Choices” at St. Mark’s Lutheran Church on Friday, May 20th. This daylong speaker-filled conference is devoted to discussion and education, featuring leading figures in faith, in medicine, in law, and in social services. We invite you to register.
As a society, we are grappling with the idea that life is, and should be, more than just the absence of its opposite. Books and films like Gawande’s, and programs at IOA, can help us accept that beautiful realization.
