Title: Being Mortal: Medicine and What Matters in the End
Author: Atul Gawande
Genre: Current Issues/Philosophy
Trigger Warnings: Death, death of parents, dying, aging, medical procedures, cancer
Back Cover:
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.
Through eye-opening research and gripping stories of his own patients and family, Atul Gawande, a practicing surgeon, reveals the suffering this dynamic has produced. Nursing homes, devoted above all to safety, battle with residents over the food they are allowed to eat and the choices they are allowed to make. Doctors, uncomfortable discussing patients’ anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them.
In his bestselling books, Gawande has fearlessly revealed the struggles of his profession. Now he examines its ultimate limitations and failures–in his own practices as well as others’–as life draws to a close. Riveting, honest, and humane, Being Mortal shows how the ultimate goal is not a good death but a good life–all the way to the very end.
Review:
This is a really interesting book, and though the topic of illness, aging, and inevitable death is not exactly one people like thinking about, Atul Gawande proposes that the process of dying would be a less horrible experience if we did think about them.
There are a lot of different examples covered in this book, from people interviewed for this book to people Atul has seen in his own practice as a surgeon to his own father’s process of dying. But everything really comes down to a few main ideas:
- You are 100% going to die eventually and it will likely be a process, so it’s essential to think about what you want and tell the people who will be making decisions for you when you’re incapacitated.
- The medical profession is more focused on solving individual problems than how those solutions will affect quality of life, even in terminal patients, and that’s something that should be changed.
- Elder care facilities like nursing homes are more focused on safety than supporting those people who need daily assistance to live the life they want, and that also should be changed.
- Every medical intervention comes with a quality of life tradeoff, and people who are terminal (whether from age or illness) and their families are usually happier and more satisfied if quality of life takes precidence over extending life.
Though at times the book felt a little longer than it needed to be and the tendency to start an example, move on to another one, and then go back to finish the first made it hard to follow at times (possibly exaggerated by the fact that I read this as an audiobook), this was a really good read. Not necessarily one that I enjoyed, but it was engaging and I think the topic is important.
I have been thinking about and preparing for my death for the last few years. I’m not terminally ill or elderly or anything, I just have a certainty (despite a complete lack of evidence) that I’m going to die at or before age 30. So these kinds of discussions don’t make me uncomfortable because I’ve been having them with myself and my husband fairly regularly. If you’re not prepared to face your own mortality, this book may make you very uncomfortable. But at the same time, it’s important to think about what trade-offs you’re willing to make and what things are non-negotiable for you. If it came down to “This surgery will save your life but you won’t be able to do X anymore,” is it worth it to you to live without X or would you rather focus on comfort care than live without X? These are the kinds of questions this book makes you consider.
It also makes you rethink nursing homes. If you’ve ever visited an older relative in a nursing home, looked for a nursing home for yourself or your parent(s), or happen to be like me and did nurse aide clinicals in a nursing home, you know nobody likes being there and they’re sad, depressing places full of sad old people waiting to die. And this book makes a good point that nursing homes focus on safety over agency – keeping the people alive at the cost of giving them any control over their lives, being an institution instead of “home” for the people who live there.
This review could get really long if I addressed every good point it made. It made a ton of them, and has a bunch of stuff worth talking about. Though it doesn’t really give advice for actually having these conversations (my husband really does not think, “Happy birthday! Now that you’re getting older, let’s talk about end-of-life wishes” is going to go over well), they’re essential.
Bluejay Reads 