Synopsis (Goodreads): Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of ageing 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 extends 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.
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.
What is it about surgeons that make them such good writers? Paul Kalanithi’s When Breath Becomes Air is one of my recent favourites – a beautifully written meditative memoir on what it takes to live a meaningful life.
I think maybe it is the use of the simplest of language in such a beautiful way, creating an engaging and compassionate narrative with no room for self-pity. This is especially important when you consider what Being Mortal is about.
Terminal illnesses, aging, dying: these are all heavy subjects to tackle in less than 300 pages, but Gawande delves deep into the ways in which medicine needs to evolve from simply ensuring health and survival to enabling well being. He looks at why we need to recognise that even now the power of medicine is finite when coping with the constraints imposed by biology, and stresses on the importance of having those hard and honest conversations with those in your care to ensure that you understand how they may live their final moments and/or die honouring what they value most, whether it be being able to spend time at home with loved ones without a drug-induced grogginess, or living only until they can eat and enjoy chocolate ice-cream.
Modern life has diluted the central role of the family unit and increased individual independence – this is not necessarily a bad thing because more and more people are living life autonomously and on their terms, getting the best of both worlds. Living your life to the fullest, but knowing you have that safety and support of the family net when you need it. However, it’s only when you truly need it…when you are in danger of losing that independence and self-sufficiency, that you realise deep down how little you want that support. You don’t want to be reliant on someone else to do the simplest of tasks because you are unable to take care of yourself…and Atul Gawande rightly points out how the entire field of medicine is totally underprepared on how to handle this. Don’t get me wrong, doctors do great work – but there is always that danger of becoming desensitised to pain, illness and suffering when you have a higher level of exposure to it. Two passages from the book really resonated for me, on what a loss of independence entails, and on how someone would ideally want to end their life, and I have shared them below.
It is not death that the very old tell me they fear. It is what happens short of death – losing their hearing, their memory, the best friends, their way of life. As Felix put it to me, “Old age is a continuous series of losses.”
Technological society has forgotten what scholars call the “dying role” and its importance to people as life approaches end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms. This role is, observers argue, among life’s most important, for both the dying and those left behind.
This book shifted my thinking on how we interact with the elderly and the infirm, and on the importance of being more conscious and empathetic to their wants, not just their needs…helping them to preserve the integrity of their lives and continuing to be its authors in the ways that matter most to them right up to the very end. Give it a chance to do the same for you.