The Beautiful Humility of Being Mortal with Dr. Atul Gawande

Hi. I’m going to take a risk, as someone who was raised Hindu, and quote from the Bible in order to reflect on what compassion means to me.

This is from Isaiah:

“The voice said, ‘Cry.’ And he said, ‘What shall I cry? All flesh is grass, and all the goodliness thereof is as the flower of the field. The grass withereth, the flower fadeth, because the spirit of the Lord bloweth upon it. Surely the people is grass.’”

This passage is saying that life is transitory.

In the Mahabharata, the warrior Karna says, “I see it now. The world is swiftly passing.”

Grappling with this reality is a central theme and task of religion. It has not, however, been treated as a central theme and task of modern society.

We’ve medicalized the experience of being transitory creatures of flesh and bone, cells and genes. Of being mortal.

And the result is often suffering.

We’ve accumulated great powers to diagnose, treat and heal. But we do not escape the great unfixables: sickness, aging, frailty and dying.

I’m a co-founder of the Massachusetts Coalition for Serious Illness Care. We’ve been conducting surveys every year for the past few years, and what we find is that only about half of people with a serious health condition have had a conversation with their family about their wishes for medical care and their priorities.

Only about a quarter have had those conversations with their care providers.

And when they do have those conversations, they’re not at all confident that their wishes will be followed.

That should be an outrage. That should be a scandal.

That is a systems failure.

And it has become unbearably evident during the coronavirus pandemic.

We’ve been putting elderly and disabled people in solitary confinement for months.

That was understandable during the first few weeks, when we didn’t understand anything about the virus or how to keep people safe. We saw entire units where elderly and disabled people died.

But now we know how to keep people safe.

I have family members with serious health issues who need long-term care. But we’re told that we have to sign away the possibility that we’ll ever see them again or hug them again.

That is simply unacceptable.

They won’t provide the personal protective equipment and training needed to make those things possible.

And that is outrageous.

With the Massachusetts Coalition for Serious Illness Care, we’re working to establish a higher standard for visitation policies.

I think that’s one small example of what can be done to recognize that people can have full, meaningful lives all the way to the very end.

But we need to give everyone that chance.

And we need to devote our capabilities to supporting it.

It’s clear that we have work to do.

This lesson applies anytime people need the help of others, not only at the end of life.

We must ask what their priorities are for their care.

Then we must listen.

And when institutions fail, we must call it out.

Thank you to all of you who are working to make that happen.