Boundaries, Medicine, and You

What makes your life worth living is one of the most intimate and important things for you to know about yourself. What matters most to you may be under construction. What matters most will change many times over the course of your lifetime.

In the book Being Mortal, you get to stand inside Dr. Gawande’s head as he asks the most important questions about where is the line, the boundary, where medicine does more harm than good.

On every page of this book I thought of my conversations with clients over the years. What is most important to you right now? Since I don’t have any medicine to offer, when my clients are struggling with serious health issues, as a therapist my tools are to help people know, truly know, what matters most to them and sort out how they want to proceed with their medical care.

As I read Being Mortal, Dr. Gawande explains what he has learned through these conversations. But he is honest about how ill-equipped he was to have these conversations, regrets he had, and how he sees other doctors struggling as well, and the insight he gained about boundaries.

The book made me think about my dad, who passed away 11 years ago this month. There was a point when he was in the hospital, on life support, with absolutely nothing his medical team could offer him.

I became aware that his doctor couldn’t deal with the fact that he had nothing to offer. I found myself stepping in with my therapy skills, helping the doctor process his own thoughts, and helping him understand that he needed to tell my father the truth so my father could decide what mattered most. It took several conversations but I finally broke through when the doctor cried as he explained he had nothing to offer my dad. And my dad chose to be removed from life support and released from the narrow confines of the hospital bed where he was freezing most of the time, and go home.

I was the person who literally turned off the machines and unplugged my father from “life support”. Though nothing truly dramatic happened, he didn’t die when the machines went off. I rode with him in an ambulance home. He spent his remaining time where he wanted to be.
I review this moment over and over in my head, not second guessing any of it. Just because it was the most intimate conversation I ever had with my dad, hearing him say what mattered most for his remaining days was to be at home. And to hear him choose to be unplugged from life-support (what a provocative word) and leave the hospital, knowing he would not return for treatment or a cure.
On the pages of Being Mortal, I finally had some closure. I felt relieved watching a doctor come to terms with the boundary, finding the line, and understanding how important it is for a person to decide what matters most to them.

“When I was a child, the lessons my father taught me had been about perseverance: never to accept the limitations that stood in my way. As an adult watching him in his final years, I also saw how to come to terms with limits that couldn’t simply be wished away. When to shift from pushing against limits to making the best of them is not often readily apparent. But it is clear that there are times when the cost of pushing exceeds its value.”- Dr. Atul Gawande