Chapman University Panic Attack on Live Television Video Analysis Paper Two pages essay for a sociology of death class. The essay is about integrating all

Chapman University Panic Attack on Live Television Video Analysis Paper Two pages essay for a sociology of death class. The essay is about integrating all materials in a core theme then address it.

*Be comprehensive of the readings

*ASA format for the sources

I will copy some links for the videos you have to use in the essay and I’ll upload some books.

https://www.youtube.com/watch?v=RtYyT6Hl3ms Being Mortal
is the author of three bestselling books:
Complications, a finalist for the National Book Award;
Better, selected by Amazon.com as one of the ten best
books of 2007; and The Checklist Manifesto. He is also a
surgeon at Brigham and Women’s Hospital in Boston, a
staff writer for the New Yorker, and a professor at
Harvard Medical School and the Harvard School of
Public Health. He has won the Lewis Thomas Prize for
Writing about Science, a MacArthur Fellowship, and two
National Magazine Awards. In his work in public health,
he is director of Ariadne Labs, a joint centre for health
system innovation, and chairman of Lifebox, a nonprofit
organisation making surgery safer globally. In 2014,
Gawande gave the Radio 4 Reith Lectures series, entitled
‘The Future of Medicine’, based upon Being Mortal. He
and his wife have three children and live in Newton,
Massachusetts.
ATUL GAWANDE
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Also by Atul Gawande
Complications: A Surgeon’s Notes on an Imperfect
Science
Better: A Surgeon’s Notes on Performance
The Checklist Manifesto: How to Get Things Right
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Being Mortal
Atul Gawande
Aging, Illness, Medicine and What Matters in the End
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First published in Great Britain in 2014 by
PROFILE BOOKS LTD
3A Exmouth House
Pine Street
London EC1R 0JH
www.profilebooks.com
Published in association with Wellcome Collection
Wellcome Collection is a free visitor destination for the
incurably curious. It explores the connections between
medicine, life and art in the past, present and future.
Wellcome Collection is part of the Wellcome Trust, a
global charitable foundation dedicated to achieving
extraordinary improvements in human and animal health.
Wellcome Collection
183 Euston Road
London NWI 2BE
www.wellcomecollection.org
First published in the United States of America in 2014
by
Metropolitan Books, Henry Holt and Company, LLC
Copyright © Atul Gawande, 2014
‘Things Fall Apart’ and ‘Letting Go’ were previously
published in different form in the New Yorker magazine.
The moral right of the author has been asserted.
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All rights reserved. Without limiting the rights under
copyright reserved above, no part of this publication may
be reproduced, stored or introduced into a retrieval
system, or transmitted, in any form or by any means
(electronic, mechanical, photocopying, recording or
otherwise), without the prior written permission of both
the copyright owner and the publisher of this book.
A CIP catalogue record for this book is available from the
British Library.
eISBN 978 1 84765 786 2
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To Sara Bershtel
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I see it now—this world is swiftly passing.
—the warrior Karna, in the Mahabharata
They come to rest at any kerb:
All streets in time are visited.
—Philip Larkin, “Ambulances”
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Contents
Introduction
1 • The Independent Self
2 • Things Fall Apart
3 • Dependence
4 • Assistance
5 • A Better Life
6 • Letting Go
7 • Hard Conversations
8 • Courage
Epilogue
Notes on Sources
Acknowledgments
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Introduction
I learned about a lot of things in medical school, but
mortality wasn’t one of them. Although I was given a
dry, leathery corpse to dissect in my first term, that was
solely a way to learn about human anatomy. Our
textbooks had almost nothing on aging or frailty or dying.
How the process unfolds, how people experience the end
of their lives, and how it affects those around them
seemed beside the point. The way we saw it, and the way
our professors saw it, the purpose of medical schooling
was to teach how to save lives, not how to tend to their
demise.
The one time I remember discussing mortality was during
an hour we spent on The Death of Ivan Ilyich, Tolstoy’s
classic novella. It was in a weekly seminar called
Patient-Doctor—part of the school’s effort to make us
more rounded and humane physicians. Some weeks we
would practice our physical examination etiquette; other
weeks we’d learn about the effects of socioeconomics
and race on health. And one afternoon we contemplated
the suffering of Ivan Ilyich as he lay ill and worsening
from some unnamed, untreatable disease.
In the story, Ivan Ilyich is forty-five years old, a midlevel
Saint Petersburg magistrate whose life revolves mostly
around petty concerns of social status. One day, he falls
off a stepladder and develops a pain in his side. Instead of
abating, the pain gets worse, and he becomes unable to
work. Formerly an “intelligent, polished, lively and
agreeable man,” he grows depressed and enfeebled.
Friends and colleagues avoid him. His wife calls in a
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series of ever more expensive doctors. None of them can
agree on a diagnosis, and the remedies they give him
accomplish nothing. For Ilyich, it is all torture, and he
simmers and rages at his situation.
“What tormented Ivan Ilyich most,” Tolstoy writes, “was
the deception, the lie, which for some reason they all
accepted, that he was not dying but was simply ill, and he
only need keep quiet and undergo a treatment and then
something very good would result.” Ivan Ilyich has
flashes of hope that maybe things will turn around, but as
he grows weaker and more emaciated he knows what is
happening. He lives in mounting anguish and fear of
death. But death is not a subject that his doctors, friends,
or family can countenance. That is what causes him his
most profound pain.
“No one pitied him as he wished to be pitied,” writes
Tolstoy. “At certain moments after prolonged suffering
he wished most of all (though he would have been
ashamed to confess it) for someone to pity him as a sick
child is pitied. He longed to be petted and comforted. He
knew he was an important functionary, that he had a
beard turning grey, and that therefore what he longed for
was impossible, but still he longed for it.”
As we medical students saw it, the failure of those around
Ivan Ilyich to offer comfort or to acknowledge what is
happening to him was a failure of character and culture.
The late-nineteenth-century Russia of Tolstoy’s story
seemed harsh and almost primitive to us. Just as we
believed that modern medicine could probably have cured
Ivan Ilyich of whatever disease he had, so too we took for
granted that honesty and kindness were basic
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responsibilities of a modern doctor. We were confident
that in such a situation we would act compassionately.
What worried us was knowledge. While we knew how to
sympathize, we weren’t at all certain we would know
how to properly diagnose and treat. We paid our medical
tuition to learn about the inner process of the body, the
intricate mechanisms of its pathologies, and the vast trove
of discoveries and technologies that have accumulated to
stop them. We didn’t imagine we needed to think about
much else. So we put Ivan Ilyich out of our heads.
Yet within a few years, when I came to experience
surgical training and practice, I encountered patients
forced to confront the realities of decline and mortality,
and it did not take long to realize how unready I was to
help them.
when I was a junior surgical resident,
and in one of my very first essays, I told the story of a
man whom I called Joseph Lazaroff. He was a city
administrator who’d lost his wife to lung cancer a few
years earlier. Now, he was in his sixties and suffering
from an incurable cancer himself—a widely metastatic
prostate cancer. He had lost more than fifty pounds. His
abdomen, scrotum, and legs had filled with fluid. One
day, he woke up unable to move his right leg or control
his bowels. He was admitted to the hospital, where I met
him as an intern on the neurosurgical team. We found that
the cancer had spread to his thoracic spine, where it was
compressing his spinal cord. The cancer couldn’t be
cured, but we hoped it could be treated. Emergency
radiation, however, failed to shrink the cancer, and so the
neurosurgeon offered him two options: comfort care or
I BEGAN WRITING
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surgery to remove the growing tumor mass from his
spine. Lazaroff chose surgery. My job, as the intern on
the neurosurgery service, was to get his written
confirmation that he understood the risks of the operation
and wished to proceed.
I’d stood outside his room, his chart in my damp hand,
trying to figure out how to even broach the subject with
him. The hope was that the operation would halt the
progression of his spinal cord damage. It wouldn’t cure
him, or reverse his paralysis, or get him back to the life
he had led. No matter what we did he had at most a few
months to live, and the procedure was inherently
dangerous. It required opening his chest, removing a rib,
and collapsing a lung to get at his spine. Blood loss
would be high. Recovery would be difficult. In his
weakened state, he faced considerable risks of
debilitating complications afterward. The operation posed
a threat of both worsening and shortening his life. But the
neurosurgeon had gone over these dangers, and Lazaroff
had been clear that he wanted the operation. All I had to
do was go in and take care of the paperwork.
Lying in his bed, Lazaroff looked gray and emaciated. I
said that I was an intern and that I’d come to get his
consent for surgery, which required confirming that he
was aware of the risks. I said that the operation could
remove the tumor but leave him with serious
complications, such as paralysis or a stroke, and that it
could even prove fatal. I tried to sound clear without
being harsh, but my discussion put his back up. Likewise
when his son, who was in the room, questioned whether
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heroic measures were a good idea. Lazaroff didn’t like
that at all.
“Don’t you give up on me,” he said. “You give me every
chance I’ve got.” Outside the room, after he signed the
form, the son took me aside. His mother had died on a
ventilator in intensive care, and at the time his father had
said he did not want anything like that to happen to him.
But now he was adamant about doing “everything.”
I believed then that Mr. Lazaroff had chosen badly, and I
still believe this. He chose badly not because of all the
dangers but because the operation didn’t stand a chance
of giving him what he really wanted: his continence, his
strength, the life he had previously known. He was
pursuing little more than a fantasy at the risk of a
prolonged and terrible death—which was precisely what
he got.
The operation was a technical success. Over eight and a
half hours, the surgical team removed the mass invading
his spine and rebuilt the vertebral body with acrylic
cement. The pressure on his spinal cord was gone. But he
never recovered from the procedure. In intensive care, he
developed respiratory failure, a systemic infection, blood
clots from his immobility, then bleeding from the blood
thinners to treat them. Each day we fell further behind.
We finally had to admit he was dying. On the fourteenth
day, his son told the team that we should stop.
It fell to me to take Lazaroff off the artificial ventilator
that was keeping him alive. I checked to make sure that
his morphine drip was turned up high, so he wouldn’t
suffer from air hunger. I leaned close and, in case he
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could hear me, said I was going to take the breathing tube
out of his mouth. He coughed a couple of times when I
pulled it out, opened his eyes briefly, and closed them.
His breathing grew labored, then stopped. I put my
stethoscope on his chest and heard his heart fade away.
Now, more than a decade after I first told Mr. Lazaroff’s
story, what strikes me most is not how bad his decision
was but how much we all avoided talking honestly about
the choice before him. We had no difficulty explaining
the specific dangers of various treatment options, but we
never really touched on the reality of his disease. His
oncologists, radiation therapists, surgeons, and other
doctors had all seen him through months of treatments for
a problem that they knew could not be cured. We could
never bring ourselves to discuss the larger truth about his
condition or the ultimate limits of our capabilities, let
alone what might matter most to him as he neared the end
of his life. If he was pursuing a delusion, so were we.
Here he was in the hospital, partially paralyzed from a
cancer that had spread throughout his body. The chances
that he could return to anything like the life he had even a
few weeks earlier were zero. But admitting this and
helping him cope with it seemed beyond us. We offered
no acknowledgment or comfort or guidance. We just had
another treatment he could undergo. Maybe something
very good would result.
We did little better than Ivan Ilyich’s primitive
nineteenth-century doctors—worse, actually, given the
new forms of physical torture we’d inflicted on our
patient. It is enough to make you wonder, who are the
primitive ones.
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has profoundly altered
the course of human life. People live longer and better
than at any other time in history. But scientific advances
have turned the processes of aging and dying into medical
experiences, matters to be managed by health care
professionals. And we in the medical world have proved
alarmingly unprepared for it.
MODERN SCIENTIFIC CAPABILITY
This reality has been largely hidden, as the final phases of
life become less familiar to people. As recently as 1945,
most deaths occurred in the home. By the 1980s, just 17
percent did. Those who somehow did die at home likely
died too suddenly to make it to the hospital—say, from a
massive heart attack, stroke, or violent injury—or were
too isolated to get somewhere that could provide help.
Across not just the United States but also the entire
industrialized world, the experience of advanced aging
and death has shifted to hospitals and nursing homes.
When I became a doctor, I crossed over to the other side
of the hospital doors and, although I had grown up with
two doctors for parents, everything I saw was new to me.
I had certainly never seen anyone die before and when I
did it came as a shock. That wasn’t because it made me
think of my own mortality. Somehow the concept didn’t
occur to me, even when I saw people my own age die. I
had a white coat on; they had a hospital gown. I couldn’t
quite picture it the other way round. I could, however,
picture my family in their places. I’d seen multiple family
members—my wife, my parents, and my children—go
through serious, life-threatening illnesses. Even under
dire circumstances, medicine had always pulled them
through. The shock to me therefore was seeing medicine
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not pull people through. I knew theoretically that my
patients could die, of course, but every actual instance
seemed like a violation, as if the rules I thought we were
playing by were broken. I don’t know what game I
thought this was, but in it we always won.
Dying and death confront every new doctor and nurse.
The first times, some cry. Some shut down. Some hardly
notice. When I saw my first deaths, I was too guarded to
cry. But I dreamt about them. I had recurring nightmares
in which I’d find my patients’ corpses in my house—in
my own bed.
“How did he get here?” I’d wonder in panic.
I knew I would be in huge trouble, maybe criminal
trouble, if I didn’t get the body back to the hospital
without getting caught. I’d try to lift it into the back of
my car, but it would be too heavy. Or I’d get it in, only to
find blood seeping out like black oil until it overflowed
the trunk. Or I’d actually get the corpse to the hospital
and onto a gurney, and I’d push it down hall after hall,
trying and failing to find the room where the person used
to be. “Hey!” someone would shout and start chasing me.
I’d wake up next to my wife in the dark, clammy and
tachycardic. I felt that I’d killed these people. I’d failed.
Death, of course, is not a failure. Death is normal. Death
may be the enemy, but it is also the natural order of
things. I knew these truths abstractly, but I didn’t know
them concretely—that they could be truths not just for
everyone but also for this person right in front of me, for
this person I was responsible for.
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The late surgeon Sherwin Nuland, in his classic book
How We Die, lamented, “The necessity of nature’s final
victory was expected and accepted in generations before
our own. Doctors were far more willing to recognize the
signs of defeat and far less arrogant about denying them.”
But as I ride down the runway of the twenty-first century,
trained in the deployment of our awesome arsenal of
technology, I wonder exactly what being less arrogant
really means.
You become a doctor for what you imagine to be the
satisfaction of the work, and that turns out to be the
satisfaction of competence. It is a deep satisfaction very
much like the one that a carpenter experiences in
restoring a fragile antique chest or that a science teacher
experiences in bringing a fifth grader to that sudden,
mind-shifting recognition of what atoms are. It comes
partly from being helpful to others. But it also comes
from being technically skilled and able to solve difficult,
intricate problems. Your competence gives you a secure
sense of identity. For a clinician, therefore, nothing is
more threatening to who you think you are than a patient
with a problem you cannot solve.
There’s no escaping the tragedy of life, which is that we
are all aging from the day we are born. One may even
come to understand and accept this fact. My dead and
dying patients don’t haunt my dreams anymore. But
that’s not the same as saying one knows how to cope with
what cannot be mended. I am in a profession that has
succeeded because of its ability to fix. If your problem is
fixable, we know just what to do. But if it’s not? The fact
that we have had no adequate answers to this question is
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troubling and has caused callousness, inhumanity, and
extraordinary suffering.
This experiment of making mortality a medical
experience is just decades old. It is young. And the
evidence is it is failing.
book about the modern experience of
mortality—about what it’s like to be creatures who age
and die, how medicine has changed the experience and
how it hasn’t, where our ideas about how to deal with our
finitude have got the reality wrong. As I pass a decade in
surgical practice and become middle-aged myself, I find
that neither I nor my patients find our current state
tolerable. But I have also found it unclear what the
answers should be, or even whether any adequate ones
are possible. I have the writer’s and scientist’s faith,
however, that by pulling back the veil and peering in
close, a person can make sense of what is most confusing
or strange or disturbing.
THIS IS A
You don’t have to spend much time with the elderly or
those with terminal illness to see how often medicine fails
the people it is supposed to help. The waning days of our
lives are given over to treatments that addle our brains
and sap our bodies for a sliver’s chance of benefit. They
are spent in institutions—nursing homes and intensive
care units—where regimented, anonymous routines cut us
off from all the things that matter to us in life. Our
reluctance to honestly examine the experience of aging
and dying has increased the harm we inflict on people
and denied them the basic comforts they most need.
Lacking a coherent view of how people might live
successfully all the way to their very end, we have
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allowed our fates to be controlled by the imperatives of
medicine, technology, and strangers.
I wrote this book in the hope of understanding what has
happened. Mortality can be a treacherous subject. Some
will be alarmed by the prospect of a doctor’s writing
about the inevitability of decline and death. For many,
such talk, however carefully framed, raises the specter of
a society readying itself to sacrifice its sick and aged. But
what if the sick and aged are already being
sacrificed—victims of our refusal to accept the
inexorability of our life cycle? And what if there are
better approaches,…
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