Posts Tagged 'Atul Gawande'

Being Mortal and Moral: Gawande and the Red Heifer

In 2014 Atul Gawande wrote Being Mortal: Medicine and What Matters in the End addressing end-of-life care, hospice care, and his reflections and personal stories. It is one of those paradigm busting must reads.

Being Mortal is a meditation on how people can better live with age-related frailty, serious illness, and approaching death. Gawande calls for a change in the way that medical professionals treat patients approaching their ends. He recommends that instead of focusing on survival, practitioners should work to improve quality of life and enable well-being. Gawande shares personal stories of his patients’ and his own relatives’ experiences, the realities of old age which involve broken hips and dementia, overwhelmed families and expensive geriatric care, and loneliness and loss of independence.

I got to thinking about this in the context of reading Chukat, this week’s Torah portion. There the Israelite people are instructed to bring a red heifer without blemish, in which there is no defect and on which no yoke has been laid to sacrifice. The critical ritual involved the ash from this perfect cow. There we read:

Another party who is pure shall take hyssop, dip it in the water, and sprinkle on the tent and on all the vessels and people who were there, or on the one who touched the bones or the person who was killed or died naturally or the grave. The pure person shall sprinkle it upon the impure person on the third day and on the seventh day, thus purifying that person by the seventh day. [The one being purified] shall then wash those clothes and bathe in water—and at nightfall shall be pure. If any party who has become impure fails to undergo purification, that person shall be cut off from the congregation for having defiled God’s sanctuary. The water of lustration was not dashed on that person, who is impure.

Numbers 19:18-20

While Israelite society was much more at home with death than our own, there is an interesting notion that there is no room for death in God’s house. Just as Gawande points out, there is a taboo of death that we are struggling to make sense of in their lives.

Gawande also points out how this dynamic impacts how generations deal with each other. This comes into focus when we think about the exceptional and rare case of actually finding a perfect red cow as we learn about in our Torah portion. In the Gemara we learn an amazing story about Dama ben Nesina. There we learn:

Rav Yehuda says that Shmuel says: They asked Rabbi Eliezer: How far must one go to fulfill the mitzva of honoring one’s father and mother? Rabbi Eliezer said to them: Go and see what one gentile did for his father in Ashkelon, and the name of the son was Dama ben Netina. Once the Sages wished to purchase precious stones from him for the ephod of the High Priest for six hundred thousand gold dinars’ profit, and Rav Kahana taught that it was eight hundred thousand gold dinars’ profit. And the key to the chest holding the jewels was placed under his father’s head, and he would not disturb him. The next year the Holy One, Blessed be God, gave Dama ben Netina his reward, as a red heifer was born in his herd, and the Jews needed it. When the Sages of Israel came to him he said to them: I know, concerning you, that if I were to ask for all the money in the world you would give it to me.

Kidushin 31a 

Gawande offers us a lens to see our distance from death and an older generation. Like Being Mortal, the ritual of the Red Heifer gives us a window into how we might reconnect with our own mortality and morality.

Other posts on Gawande:

Good Life: Death and Chukkat

In Chukkat, this week’s Torah portion, we learn about the bizarre rite of the para adumma– red heifer.  It was a cow brought to the priests as a sacrifice, and its ashes were used for the ritual purification of Ṭum’at HaMet (“the impurity of the dead”), that is, an Israelite who had come into contact with a corpse. It does seems strange that some how the ash of one dead animal would deal with their fear of having come into contact with a dead body. The notion of a para adumma seems out of step with our lives. How do we make sense of this in the 21st Century?

I was thinking about this question when reading Atul Gawande’s  Being Mortal: Medicine and What Matters in the End. In his bestselling book, Atul Gawande, a practicing surgeon, has fearlessly revealed the struggles of his profession. Here he examines its ultimate limitations and failures – in his own practices as well as others’ – as life draws to a close. And he discovers how we can do better. He follows a hospice nurse on her rounds, a geriatrician in his clinic, and reformers turning nursing homes upside down. There he writes:

Medicine has triumphed in modern times, transforming the dangers of childbirth, injury, and disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should.

In today’s day we have removed death from our lives. Even doctors, uncomfortable discussing patients’ anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them. And we the families go along with all of it.

So while it is crazy to imagine how the para adumma removed the impurity of death from the Israelites lives, it seems even crazier that we have feebly tried to removed death itself from our modern lives. We might not find ourselves going to the Priest for a consult, but we should find people who show us how to have the hard conversations about death before it is too late. Gawande writes:

Our ultimate goal, after all, is not a good death but a good life to the very end.

 

Priority List: What Yitro Has To Teach Us This Year

Despite the fact that we are almost done with January, I feel that the year has just started. And yet some how my To-Do list is already too long with hardly enough checked off. How will I ever get through it all this year? But I do not feel alone. It seems that we all have too many things to do. Making lists help us structure and prioritize our time, but do the lists represent us? Do these to-do- lists portray our personal, professional, or organizational values? While we want to be accomplished, do we want to be identified just as the people who do the things on our lists? Is there a soul to our lists?

Wanting to check “write blog post” off the list I turned to Yitro, this week’s Torah portion. There we read about the receiving of the Torah and the Ten Commandments. Interestingly enough, there was a period in Jewish history when they wanted to read the Ten Commandments in the synagogue liturgically. This practice was rejected for fear that people would think that the entire teaching of the Torah was just this To-Do (or Not-To-Do) List. Surely these ten commandments are important, but what is their relationship to the other 603 commandments? Are these a list of priorities or values? If they are a list of values, how does the rest of the Torah spell out these values? And if they are priorities, does this really manifest the values of the rest of the Torah? Or more importantly how does a list speak to the soul?

This got me thinking about Atul Gawande‘s 2009 The Checklist Manifesto . Gawande points out that, while airplane pilots use checklists to ensure optimal outcomes, surgeons do not. While the surgeon might think that their education is beyond needing a remedial checklist, that is not the biggest difference. The biggest difference is if the surgeon fails the patient dies while if the airplane pilot fails he goes down with the ship. It is easy to distance yourself when you do not have as much invested in the outcomes. The book’s main point is simple: no matter how expert you may be, well-designed check lists can improve outcomes.

It is impossible for me to read Yitro without think about our beloved FJC’s Yitro Program for assistant and associate directors (ADs) of Jewish camps across North America. With the continued support of the AVI CHAI Foundation this program is running its third cohort. Yes, I love each cohort equally. In this program we are training these ADs to enhance the Jewish experience at their home camp. In short they need to explore the soul of their camps. As everyone knows these ADs have a crushing amount of work to do. Their To-Do-Lists would give most people apoplexy.  Together in this program we are doing the hard work of defining and elevating the soul of these lists.

Taking their example to heart I think it makes sense for all of us to review our lists for the coming year to ensure that our values and priorities are aligned. We all have a lot of work to do to live accomplished value driven lives.


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