Being Mortal: Medicine and What Matters in the End
Atul Gawande (Facebook) (Twitter)
Audiobook read by Robert Petkoff
Metropolitan Books (2014), Hardcover (ISBN 0805095152 / 9780805095159)
Nonfiction, 304 pages
Source: Purchased audiobook (Macmillan Audio, October 2014, ISBN 9781427244246; Audible ASIN B00NPAJ32S)
My father just turned 86 years old. My mother-in-law will be 77 this summer. Both have outlived spouses after decades-long marriages. Both are still able to live on their own, both still work part-time, and both keep busy. But there’s no telling how much longer this status will remain status quo for either of them. The human body is not built to last indefinitely, and while the last century’s dramatic advances in medicine have certainly helped it last many years longer than it once did, things will start to fail eventually. Sometimes this comes dramatically and sometimes it’s gradual, but it will happen.
The knowledge that it will happen doesn’t it make it any easier to think or talk about, but one thing that Atul Gawande attempts to convey in Being Mortal: Medicine and What Matters in the End is that actually dealing with what will happen does require thought and conversation, and ideally those take place before things really do start happening.
Bookended by personal reflections on the very different end-of-life experiences of his grandfather and his father, Being Mortal explores various ways in which modern, developed societies deal with their aging populations. The combined effects of two significant shifts—from extended families living close together to smaller, more geographically-dispersed households, and the simple fact of longer lifespans—have created difficulties we’re struggling to address. We’re still learning what “normal” aging looks like as average life expectancy approaches 80 years. We’re learning that in the absence of specific illnesses, medicine may not offer the most appropriate responses to its challenges; Gawande observes that doctors are trained to cure, and aging simply isn’t curable. However, even in mostly healthy people, aging does produce real physical and mental changes that alter how one functions in the world, and individuals and families need to learn to recognize and make provisions for them. There are many things to consider, and that may need to be revisited often:
- What can they still manage independently?
- Do they need In-home help? How much?
- Would an assisted-living home meet their needs better?
- Do they need regular, ongoing assistance with medicines or medical equipment?
People with terminal illnesses, regardless of age, may need to confront some of the same questions as the elderly, and Being Mortal also talks about palliative care and hospice—options when treatment fails and cures don’t take. Personal stories illustrate the value of a structured communication tool in making a painfully difficult process somewhat easier to navigate, and maybe even a little less frightening.
Both my husband and I are well into the “midlife” years. We have elderly parents. We have a daughter battling leukemia, and I recently read a very enlightening book about cancer. Mortality is a concern frequently not far from my mind these days, but that doesn’t mean I was in any hurry to read Being Mortal. However, Kim is a lot younger than I am, and she convinced me that I needed to. (Ana and Jenny backed her up.) I don’t know that I’m any more eager to have these thoughts and conversations, but I do think I’m better prepared and equipped to have them now. And since nearly every one of us will need to have these conversations at some point, Being Mortal is a book I’d like to put in everyone’s hands.
Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.
Atul Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person’s last weeks or months may be rich and dignified.
Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.
From the Introduction:
“I learned about a lot of things in medical school, but mortality wasn’t one of them. Although I was given a dry, leathery corpse to dissect in my first term, that was solely a way to learn about human anatomy. Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives, and how it affects those around them seemed beside the point. The way we saw it, and the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise. The one time I remember discussing mortality was during an hour we spent on The Death of Ivan Ilyich, Tolstoy’s classic novella. It was in a weekly seminar called Patient-Doctor—part of the school’s effort to make us more rounded and humane physicians. Some weeks we would practice our physical examination etiquette; other weeks we’d learn about the effects of socioeconomics and race on health. And one afternoon we contemplated the suffering of Ivan Ilyich as he lay ill and worsening from some unnamed, untreatable disease.”