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Day: November 6, 2014

“Being Mortal: Medicine and What Matters in the End” by Atul Gawande


Being Mortal: Medicine and What Matters in the End” by Atul Gawande

c.2014, Henry Holt
304 pages


Last night’s dessert was spectacular.

As with many finales, that perfect ending to a perfect meal left you satisfied for the rest of the evening. It was, like some conclusions – a little nightcap, a final chapter, a last dance, the lingering notes of a favorite song – a thing to savor.

Can the end of life be so sweet?  Perhaps; there are steps to make it so, as you’ll see in the new book “Being Mortal” by Atul Gawande. 

For about the last century, the average lifespan for North Americans has been increasing. Modern medicine has taught doctors how to save lives but, until relatively recently, it didn’t teach them how to deal with life’s end.

That, says Gawande, is unfortunate. In many cases, doctors feel extremely uncomfortable discussing the end of life with their patients. That often leads to protocol that precludes quality of life when there isn’t much life left to have.

We’ve come to this point, this reluctance to face death, because we’re no longer familiar with it. A century ago, people died at home, often after self-treating their ailments. Hospitals were not places to get better, says Gawande; medicine back then usually had little impact on life or death. When penicillin, sulfa, and other drugs became available, however, hospitals became places for cure. Nursing homes, he says, were for people who needed additional care before going home.

But medicine isn’t the only thing that’s changed: aging has, too. We live longer, we expect our parts to last longer, and we’re surprised when health fails. But does that make aging a medical problem?

To a geriatrician, it might be – but Gawande says there aren’t enough doctors of geriatrics and, without them, we have a lessened chance to sidestep problems that could diminish the quality of life in later years. He says, in fact, that the elderly don’t dread death, so much as they dread the losses leading up to it: loss of independence, of thought, of friends.

But long before that happens, Gawande says, there are conversations that need having; namely, what treatments should, or should not, be done? How far would you want your physician to go?

Let me tell you how much I loved this book: I can usually whip through 300 pages in a night. “Being Mortal” took me three.

Part of the reason is that author Atul Gawande offers lingering food for thought in practically every paragraph – whether he writes about the history of aging and dying, one of his patients, or someone in his own family. I just couldn’t stop thinking about the points he made with his anecdotes and with this information, how it could radicalize our lives, and how it fits for just about everybody.

We are, after all, not getting any younger.

I think if you’re a caretaker for an elderly relative or if you ever plan on growing old yourself and want to maintain quality of life, this book is an absolute must-read. For you, “Being Mortal” is informative to the end.

Terri Schlichenmeyer is based in Wisconsin.

School board names new assistant super

480x270-Salem-Keizer School-District-logo

For the Keizertimes

The Salem-Keizer School Board named Kelly Carlisle, director of high schools in the district, to the vacant assistant superintendent position.

Carlisle succeeds Salem Noor, who has taken a position with the Oregon Department of Education. His appointment came at a special meeting of the board Tuesday.

Also at the special meeting, the board filled its last budget committee vacancy by appointing Adam Kohler of Salem.

Kohler, area operations manager for CenturyLink Communications, holds a master of business administration degree from Northwest Nazarene University and has extensive budgeting experience with Century Link and its local predecessor, Qwest.

Following the meeting was a work session, at which board members discussed the planned program for preparing students for college and careers.

Possible transit changes discussed


Of the Keizertimes

By recent standards, this was a light topic for members of the Keizer Planning Commission.

In the last couple of years, members have looked at weighty issues such as housing needs, Urban Growth Boundary expansion and zoning changes.

Things were a bit different at the Oct. 8 meeting: for the most part, commission members got to listen to a presentation about proposed transit changes.

Jared Choc, Planning and Technology manager for Salem-Keizer Transit and a former Planning Commission member, gave a presentation about the Moving Forward project as well as Core Network.

“Moving Forward is a look at comprehensive system changes we’re proposing for Salem and Keizer,” Choc said. “Due to budget constraints, our service was redesigned in 2009. We eliminated Saturday service and redid our service. We started to have an eye towards efficiency. We decided last year to have a pulse check to see about our efficiency.”

After some analysis, Choc said Cherriots officials came up with ideas on improving service while staying within the current budget level.

“Phase 1 is increased frequency on busy routes,” Choc said. “That’s a change from now. Now, routes operate with peak service. We’ve found bus usage is consistent through the day. Buses are running on a consistent schedule with this new phase. It will hopefully lead to increased ridership. The bus is used by commuters, but not all workers have shifts that start at 8 a.m. It’s becoming more and more of a national trend that ridership is more stable throughout the day than in the past.”

In response to a question from commission chair John Rizzo about whether the change will require more equipment, Choc said that isn’t the case.

“That number is actually decreasing with this proposal,” he said. “We would have fewer buses, more heavily used. There would be more direct routes, with fewer transfers.”

Choc is optimistic such a change could be implemented by next June.

“It will not include weekend service, but it does have more high demand service,” Choc said.

Key routes get served every 15 minutes, or twice the current amount of service. To help make that happen, some less popular or “underperforming” routes will be served every two hours instead of every hour.

Another change would eliminate the current layover in downtown Salem.

“It means you can stay on the same bus and go to anywhere on River Road or Commercial Street,” Choc said. “It’s a positive change for those who use River and Commercial. It’s a super route, if you will. It’s the new backbone for the system.”

According to Choc, Phase 2 – which would require additional funding – extends evening service.

“Not all employment ends at 5, 6, 7 p.m.,” he said. “Students are interested in later service, plus you have swing shift employees. There’s a lot of demand for evening service.”

The evening service routes would mirror daytime service, but with less frequency.

Phase 3 would be weekend and holiday service.

“Phase 3 is the one that gets everyone excited,” Choc said. “It extends Phase 1 and 2 to include all days of the week. Service levels are consistent through the day and evening. Regular service goes from 6 a.m. to 11 p.m.

Choc said Core Network is also being studied.

“It would provide the community with a guarantee of permanent, frequent service along several key corridors,” Choc said. “This service would be visible and distinct from the rest of the transit network. It would provide a level of permanence attractive to the business community. We will focus on where it would be most useful. It would be consistent 15-minute service.”

Choc noted Core Network could help establish the future of transit service in the area.

Planning Commission member Hersch Sangster noted he was on the transit board from 2004 to 2009, when service got cut.

“What they’ve done since then is amazing,” Sangster said. “I’m glad you’re still talking weekend service, because it is critical. They’re doing a lot with nothing.”