Reading Questions for Being Mortal

This week, we’ll be reading the first and second chapters of Being Mortal. For this assignment, you’ll be answering reading questions on those chapters. There will also be a separate discussion assignment to allow you a chance to talk with other students about what you read.
Submit your answers to the following questions. These questions are designed to highlight the main points of the chapters and to allow me to assess students’ understanding of them.
Reading Questions for Being Mortal:
1. Contrast Alice Hobson’s and Sitaram Gawande’s experiences of growing old, the former in the modern United States, and the latter in what Dr. Atul Gawande calls a “premodern” part of India. How are these two different experiences affected by the different world views of these two places?
2. In modern society, according to Dr. Gawande, old age and infirmity have gone from being a shared, multigenerational responsibility to a more or less private state something experienced largely alone or with the aid of doctors and institutions” (17). He analyzes the causes that he sees as being responsible for these shifts. Summarize his causal analysis.
3. At the beginning of chapter 2, Dr. Gawande states that “[m]edicine and public health have transformed the trajectory of our lives” (25), and three graphs follow to illustrate visually what he means. Explain how changes in medicine and public health have led to many of us to have old age declines that now mirror the second or third graphs instead of the first.
4. Starting on page 31, Dr. Gawande looks at both the classical and new views of aging. Summarize both of these and explain why he ultimately concludes that “the classical wear-and-tear model may explain more than we knew” (33). How does this process ultimately lead to a condition which he calls “frailty,” and what are some of the physical and mental ways in which frailty manifests itself (34)?
5. What are some of the ways in which individuals and society are harmed by our not frankly addressing this reality of frailty?
6. Dr. Gawande shadows his colleague Dr. Juergen Bludau, the chief geriatrician at the Center for Older Adult Health at his hospital, to observe how he interacts with and treats his elderly patients. When Dr. Bludau assesses patient Jean Gavrilles, what does he conclude is the “single most serious threat” she faces, and what are some of the suggestions he makes to help her make her condition “more manageable and to avert at least some of the worst effects” (41)?
7. Dr. Gawande asked Chad Boult, a geriatrics professor, what can be done “to ensure that there are enough geriatricians for the surging elderly population.” Dr. Boult explains that it is “too late” because the number of these specialists is declining and there will be a net loss with coming retirements. What alternative solution does Dr. Boult propose?
Now that you’ve completed the homework reading questions on some of the main points in chapters 1 & 2 of Being Mortal, I’d like to invite you to participate in a discussion on what you read. Please make a substantive post of at least SIX complete sentences by Wednesday, November 10th. Then respond to at least one other student’s post by Friday, November 12th. Please Note: You must complete both of these posts to receive any credit at all for the assignment.
You may discuss any point in the two chapters which struck you, but I will also give you a few ideas in case you need a starting point. (You may choose one of these or else formulate a different focus of your own.)
1. Toward the end of the chapter, Dr. Gawande tells the story of Dr. Felix Silverstone, a geriatrician whom he had quoted earlier in the book. As you’ll remember, Dr. Silverstone was still practicing medicine until he was 82, when he decided to retire because of his wife’s declining health. Recounting his transition to retirement, Dr. Silverstone said poignantly, “I didn’t think I would survive the change. I was taking apart my life as well as the house. It was terrible” (47-48). “What buoyed him, despite his limitations, was having a purpose,” notes Dr. Gawande. Some of this significant work took a professional form–he mentored a young geriatrician, he formed a professional reading group, he headed a committee to improve health care services at his retirement facility–but his primary focus became taking care of his wife, Bella. “She is my purpose now,” he shared, and he devoted a combination of his professional knowledge as a geriatrician and his personal interest as a loving spouse to this new endeavor (49-50).
Dr. Silverstone’s need for some sort of stimulation and social engagement reminded me of what Dr. Bludau said about the need for “retention of enough function for active engagement in the world” (41). It also reminded me of Dr. Gawande’s father’s wish to remain active in his community even as he faced a terminal illness. Last week’s discussion on combating loneliness also comes to mind.
This can be hard for some older people who are still healthy as well. We look forward to retirement, but it can actually be a wrenching adjustment, as it was for Dr. Silverstone. Life quickly becomes boring without meaningful activities to fill it, and some people can become quite isolated and miss the interaction that they used to have at work or with their children or other parents when they were younger adults. I have read that it’s important to retire to something as opposed to from something. Similarly, I once read in a novel the opinion that to be happy, you need to have something to love, something to look forward to, and some significant work to do.
Have you given any thought to how you will fill your own retirement with “active engagement in the world” or with significant work? (I write this aware that many of you are still pondering what career you’ll choose, let alone what your retirement will be like.) Do you have any examples around you of elderly people who are currently living fulfilling lives along these lines? Do you have any ideas of how we might reach out to elderly people to help them be less isolated and more involved with society? And this doesn’t even have to be limited to elderly people. We are currently facing an epidemic of loneliness in our society that affects other ages as well.
2. Dr. Gawande looks at how we’ve changed our views of old age from a venerated, honored position (so much so that people lied about being older than they were) to its lowered status as it became more rare and people had more opportunities to thrive outside of the multi-generational home. As I read this section, I also thought about advertising in America which is focused on younger people as companies vie for their brand identity. I see this on American tv which has long used commercials as a source of revenue. Because companies are most interested in the 18-49 demographic, they want this reflected in the casts of the shows that they sponsor. Whenever I see someone older than 40 on American tv, I tell my husband, “Oh, he’s a goner,” and sure enough, the character is often killed off in an early episode. This is very different from British tv which features characters of all ages. Older people–including older women–often hold rich, meaningful, leading roles. It’s not surprising to me that in England, old age is seen as starting at 68, when the cut-off is 62 for many other countries. Our American focus on youth was also promoted by the Baby Boomers when they were young; there was a saying, “Never trust anyone over 30.” I have seen this redefinition of old age edge further downward since; for example, I was walking down the hall one day, and I heard a student saying, “Oh he’s really old; he’s twenty-five.” Twenty-five is old? Another student wrote in his journal that at 19, he was already fearing old age.
What can we do as a nation to shift our perceptions of age? In surveys, people of every age report good things about their decade, and, indeed, there are many rewards of being older. I’ve been recently reassessing my life in middle age, and I’m happy to report that I feel less angst now, I have accumulated more resources (such as long-term friendships or an education) etc… When it comes down to it, I’d love to get rid of some of the aches I now have or to regain some of the energy I’ve lost, but I wouldn’t do it if it meant I also had to give up some of my life experience or relationships. How can we help people to fear life less and to let go of some of their ageist ideas (even as, as question 3 below notes, frailty is a part of the aging condition)?
3. Dr. Gawande talks about how we can sometimes feel as if we’ve failed if we age: “We need help, often for long periods of time, and regard that as a weakness rather than as the new normal and expected state of affairs. We’re always trotting out some story of a ninety-seven-year-old who runs marathons, as if such cases were not miracles of biological luck but reasonable expectations for all. Then when our bodies fail to live up to this fantasy, we feel as if we have something to apologize for” (28). He stresses that aging is normal: “(a)lthough the processes can be slowed–diet and physical activity can make a difference–they cannot be stopped” (31). With our society’s emphasis on youthfulness and our fear of aging and loss of independence, this can be unsettling to hear. In the later part of the book, he shares some exciting new alternative models for caring for elderly, dependent people, so we can look forward to reading about those, but do you have thoughts on Dr. Gawande’s normalization of aging and eventual frailty?
4. When Dr. Gawande was talking about the historical past and how, even when children started leaving home, there was usually one child who stayed behind to care for aging parents, “often the youngest daughter,” I thought about how many people today are still caring for their dependent elders. According to the Pew Research Center, 40.4 million caregivers provide unpaid care for Americans sixty-five-years and older. And if you look just at care for one debilitating form of illness, dementia, according to the Alzheimer’s Association: “16 million Americans provide unpaid care for people with Alzheimer’s or other dementias. These caregivers provided an estimated 18.6 billion hours of care valued at nearly $244 billion.” This responsibility can be especially taxing for “sandwich generation” caregivers, people who are both caring for dependent children and their aging parents at the same time. An article also recently appeared in the Times about elderly children who are trying to care for even older parents and who were finding the physical demands of being a caregiver in later life especially taxing.
Whether to care for older parents or not is a complicated question. Some people, like Dr. Silverstone, embrace the idea of taking care of dependent elders, and some would find it culturally unthinkable not to do so. Some find fulfillment and joy in caregiving. However, it’s also true that care needs can become almost impossible, as with the last stages of Alzheimer’s when patients can’t move independently and require round-the-clock care. Hiring outside caregivers can also be prohibitively expensive, and there isn’t currently a sufficient social safety net to provide adequate financial help. The physical, psychological, and financial demands of care-giving can be draining, especially since people can live so much longer with a debilitating condition than they used to. I heard an interview last semester on Terry Gross’s NPR program, Fresh Air, with Tia Powell, a doctor and bioethicist, about her new book, Reimagining Dementia. At the end of the interview, Gross asked Dr. Powell about her own fears of developing dementia, given her genetic history. Dr. Powell talked about her bright children and their interesting lives and said that she didn’t want them to have to make a sacrifice, like giving up a career path, to take care of her. She said we should re-think reflexively shaming people who find it to difficult to care for someone with overwhelming needs.
What are your thoughts about long-term care-giving for elders in America? Do you have any ideas for re-imagining caregiving? Should care-giving fall predominantly on the shoulders of women as it historically has? Is there a point at which it can become too much or should it be shouldered no matter what? Do caregivers need to be provided with more services than they currently have?