Monday, September 24, 2018

Being Mortal: Medicine and What Matters In the End by Atul Gawande

Being Mortal: Medicine and What Matters In The End by Atul Gawande
Narrated by Robert Petkoff
Published October 2014 by Holt, Henry and Company Inc.
Source: borrowed from my local library

Publisher's Summary:
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. 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.

My Thoughts: 
This one's been on my radar since it came out but somehow it was just never the book I picked up when I was actually paying for a book. Now, even though I've listened to it for free, I absolutely will be paying for this book. This is a book that every adult should read, particularly if you have aging parents.

Gawande has included both the stories of those who have worked to make changes in the way we deal with people as they age and personal stories of the ways systems have worked for or failed those who can no longer live on their own or are battling a terminal illness, including his own father's story. These serve to make the ideas he's exploring very approachable and easy to understand but he backs up his assertions with facts and data, as well.

Being a doctor, Gawande can speak to the fact that doctors are doing what doctors are trained to do and what the families of their patients demand be done. He recognizes that we've come a long way in the ways we care for our elderly and the infirm but wants readers to consider that there are still better ways to be considered and questions that need to be asked.

Two big takeaways for me were:

  • People are happiest when they can retain as much independence as possible. But this creates problems with being able to prove to the government (and families), that people are safe and being well cared for. As my parents are getting older, it's been my goal to try to keep them in their home as long as possible and this book confirmed that my siblings and I are doing the right thing in encouraging this. 
  • Doctors and family members need to be able to face the reality of impending death. Most importantly, we need to ask our loved ones the tough questions: what are their biggest fears and concerns? What goals are most important to them? What trade-offs are they willing to make and which ones are they not willing to make? This allows them control and helps all of us to make the right decisions. 
Gawande says this:
"Technological society has forgotten what scholars call the "dying role" and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their leagues, make people with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms."
In this day and age when we are able to keep people alive so much longer than we used to be able to, when there are so many more options for care, it's important to remember that, as the second chapter is titled, things fall apart. 
"There is always some final proximate cause that gets written down on the death certificate - respiratory failure, cardiac arrest. But in truth no single disease leads to the end: the culprit is just the accumulated crumbling of one's bodily systems while medicine carries out its maintenance measures and patch jobs...the curve of life becomes a long, slow fade."
That being said, doesn't it seem like we should be more ready for it when we get to the end, more prepared to make the best of the time we have? Gawande seems to think so and I agree.

By the time I finished this book, I was ready to go back to school to get a degree in gerontology and make a difference. Then I remembered that I could well be looking at assisted living facilities for myself by the time I could finish medical school at my age! Still, I'm going to do my damnedest to learn as much as I can so that I can be the greatest help to those I love (and myself) when the time comes to face these tough decisions. 

I suppose it would just have been easier to say to you, "You have to read this book." I would definitely encourage you to do so; it's important reading.


  1. This book was chosen by a member of my club to read, but she chose it after being diagnosed with pancreatic cancer and much of what takes place in the book took place with her in the months following the book. Her surgery went well but she could not feed herself properly and began to get weak, which prompted her doctor to put her in a home. This was exactly what she did not want. There, she got weaker. Her kids stepped in, got her into an independent living situation in Chicago and hired a personal care assistant and now she is thriving. It was heartbreaking to read this book knowing how much its content meant to her at the time. But it's such an important read. I think every DOCTOR should read it.

  2. I totally agree with what you said here. I've recommended this book to one and all. It is a very important book and as someone who has now lost both her parents, it's something that everyone should think about and plan for. I know that it's sad to consider these decisions and choices, but when the time comes, people will be glad that they planned and talked about those final decisions when they can still make them. My parents were great planners and they told me what they wanted. I did my best to make that happen for each of them - they left this life on their own terms. It was indeed sad, but I was happy that I knew what they wished and tried to follow their instructions. Glad you read this one.

  3. I loved this book. It made me get going on my own end-of-life stuff and the need to talk to my aging parents about their plans. So happy you got so much out of it like I did.

  4. I need to dust this one off and pull it off my shelf to read. I have heard only good things about it and everyone I know who has read it says it is a must read. And now you too. I remember the struggles my mom and her brothers had with their mom. I will read this one soon!