When I read Atul Gawande’s Being Mortal about a decade ago, it had a profound effect on me. Gawande is an American surgeon, writer and public health researcher, and he wrote the book after the death of his own beloved father. In it, he contemplates what constitutes a good death, and how we can optimise the end of life.
He examines two different groups of individuals nearing death; the elderly and the terminally ill. Throughout, he personalises the book with information about his own father’s passing and the problems he faced in those last months.
In considering care of the elderly, Gawande highlights just how nannyish most care homes are. Of course rules are designed to keep the residents safe, but Gawande makes us realise the harm in depriving the elderly of simple solace, be it the occasional alcoholic drink, the company of birds, cats and dogs, the delight of talking to small children or just the simple pleasure of a lie-in. Care homes tend to be rigid; patients are helped to get up from bed early in the morning and settled in a chair; mealtimes are necessarily fixed; and the terror of litigation as well as human concern for the safety of the residents means that outings are rare.
Gawande quoted for us from trials which showed that allowing any resident who wanted one a pet bird in a cage in their room (NB I don’t approve of cageing animals), and allowing a care home cat and dog, hugely increased contentment of residents. What was surprising was it also decreased morbidity and mortality. It seems that decreasing loneliness and giving people a living creature to pet and look after is beneficial to health. It’s not surprising when you think of the close ties between mind and body: we know that stress stimulates release of the glucocortoid cortisol, which has many detrimental effects on the body including immunosuppression, osteoporosis, and weight gain in the unhealthy ‘apple’ configuration. And we know that anxiety is associated with a surge in secretion of adrenaline from the adrenals, which increases heart rate and pumping intensity and can put a strain on the heart, and increased noradrenaline secretion which causes vasoconstriction which reduces blood flow to vital organs.