Being Mortal

Being Mortal by Atul Gawande Page A

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Authors: Atul Gawande
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was in his twenties. Lou would perch on a bar stool that Bob set up by the counter for him, and the two of them—the young Iranian and the old Jew—could hang out for hours. They became such good pals that they even traveled to Las Vegas together once. Lou loved going to casinos and made trips with an assortment of friends.
    Then, in 2003, at the age of eighty-five, he had a heart attack. He proved lucky. An ambulance sped him to the hospital, and the doctors were able to stent open his blocked coronary artery in time. After a couple weeks in a cardiac rehabilitation center, it was as if nothing had happened at all. Three years later, however, he had his first fall—that harbinger of unstoppable trouble. Shelley noticed that he had developed a tremor, and a neurologist diagnosed him with Parkinson’s disease. Medications controlled the symptoms, but he also began having trouble with his memory. Shelley observed that when he told a long story he sometimes lost the thread of what he was saying. Othertimes, he seemed confused about something they’d just spoken about. Most of the time he seemed fine, even exceptional for a man of eighty-eight years. He still drove. He still beat everyone at cribbage. He still looked after his home and managed his finances by himself. But then he had another bad fall, and it scared him. He suddenly felt the weight of all the changes that had been accumulating. He told Shelley he was afraid he might fall one day, hit his head, and die. It wasn’t dying that scared him, he said, but the possibility of dying alone.
    She asked him what he would think about looking at retirement homes. He wanted no part of it. He’d seen friends in those sorts of places.
    “They’re full of old people,” he said. It was not the way he wanted to live. He made Shelley promise to never put him in such a place.
    Still, he could no longer manage on his own. The only choice left for him was to move in with her and her family. So that’s what Shelley arranged for him to do.
    I asked her and her husband, Tom, how they had felt about this. Good, they both said. “I didn’t feel comfortable with him living independently anymore,” Shelley said, and Tom agreed. Lou’d had a heart attack. He was going on ninety. This was the least they could do for him. And, they admitted thinking, how long were they really going to have with him, anyway?
    TOM AND SHELLEY lived comfortably in a modest colonial in North Reading, a Boston suburb, but never completely so. Shelley worked as a personal assistant. Tom had just spent a year and half unemployed after a layoff. Now he worked for a travel company for less than he used to earn. With two teenage children in the house, there was no obvious space for Lou. But Shelley andTom converted their living room into a bedroom, moving in a bed, an easy chair, Lou’s armoire, and a flat-screen television. The rest of his furniture was sold off or put in storage.
    Cohabitation required adjustment. Everyone soon discovered the reasons that generations prefer living apart. Parent and child traded roles, and Lou didn’t like not being the master of his home. He also found himself lonelier than he expected. On their suburban cul-de-sac, he had no company for long stretches of the day and nowhere nearby to walk to—no library or video store or supermarket.
    Shelley tried to get him involved in a day program for senior citizens. She took him to a breakfast they had. He didn’t like it one bit. She discovered they made occasional trips to Foxwoods, a casino two hours from Boston. It wasn’t his favorite, but he agreed to go. She was thrilled. She hoped he’d make friends.
    She told me, “It felt like I was putting my child on the bus”—which was probably exactly what he disliked about it. “I remember saying, ‘Hi, everyone. This is Lou. This is his first time so I hope you will all be friends with him.’ ” When he came back, she asked him if he’d made any friends. No, he said. He

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