My rating: 5 stars
There are a scant number of human experiences which are common to everyone. Death is one of these. We don’t talk about death. It is the looming, proverbial “elephant in the room” that no one is willing to acknowledge. Even now, seeing this post, people are shaking their heads and wondering why on earth someone would choose to read a book about death, let alone write one. And it’s true that this topic fills my heart with fear, just like anyone else. However, what Atul Gawande has created is not a tome about death, but about living a quality life, right until the very end.
I think this is one of the most courageous and necessary books I have ever read. In Being Mortal, the author takes on the cultures of medicine, nursing homes, treatment of the elderly and terminally ill and turns the accepted conventions on their head. He highlights renegades in these fields and reveals startling research that twists what we understand to be the best “end of life” care.
We are living in the glory days of medicine with no sunset on the horizon. We have battled, and won, with infections, diseases, and debility. However, there is another side to this coin. In an era when medicine has improved to the point that our lives are extended far beyond what humans have ever been able to achieve, so-called “life saving” measures can actually cause more harm that good. Doctors are very good at prolonging life, but the question soon becomes: when is enough enough? This is not to say that people should forgo aggressive treatments when their chances for survival may actually benefit. Gawande simply posits that there comes a time when terminal is actually terminal and that people’s requests for a dignified end to their lives should be respected.
Being Mortal covers a lot of ground and offers endless inisghts and points for discussion. I’ll admit to being shocked at the statistics that said people live as long, or longer, with hospice care designed to keep them confortable, than those who continue to recieve aggressive treatments that have only a slim chance of prolonging their lives. There are three main paths to decline covered in the book; terminal illnesses like cancer, which can take their victims swiftly or draw out the final thread of life; chronic illnesses, which can be maintained with treatment but still end in eventual decline; and the condition of frailty, which results from the body aging beyond the point where it can sustain itself.
Right from the beginning, Gawande introduces the reader to personal stories of people in varying stages of age, illness, and debility. The first, and one of the most memorable, is Alice Hobson, his future wife’s grandmother. Gawande was introduced to her in 1985. Alice was bright, active, and proud of her advancing age. She lived on her own and enjoyed life on her terms. He tells her story to highlight our respect for people who can remain in their own home’s independently in their old age, then hits us with the question of what happens after independence is no longer an option. Indeed, most of us would not choose to be placed in a nursing home when we are elderly, but there seems to be no better place. The culture of nursing homes has become a “convenient” way to deal with our aging population. Here we are offered an in-depth look at the history of nursing homes (did you know they were not created as places for the elderly??) from their creation to what we see in modern times, as well as suggestions for alternatives and improvements to this type of institution. In continuing Alice’s story in the early 90’s, he laments that he did know what he does now in terms of helping people to express their wishes for how they want to live their lives in their final years. This is a cautionary tale; she becomes prone to falls and is moved to an assited living facility, falls again and breaks her hip, then ends up in the nursing ward of the home with all of her privacy and independence stripped away.
Since then, the author has been involved in some deep thinking about options for care in the final years of life and has met many people who have brought original ideas to the table for protecting the dignity and control of the aged and infirm. There were so many unexpected moments of joy in this book that uplift the spirit and make you realize that better scenarios are possible and, in fact, do exist. I feel a deep and profound respect for Atul Gawande for coming up against the accepted conventions of his profession and making some much-needed noise about what constitutes the best possible care.
There are many big questions raised in this book and I appreciate the accessible nature with which these ideas are presented. Far from being a literary “downer” or a mess of technical jargon, Gawande has put a human face on these issues and alternated bleakness with joy and hope. This was a personal book for him as it ended with his father’s slow decline at the end of his life. The reader can feel Gawande’s concern and love for people in every page of this book. He is motivated to make a change and a difference in the lives of people who are nearing the end and has presented a heartfelt, emotional symbol of hope that this can someday be achieved.
Bottom line: Everyone should read this book. The takeaways are endless, it is beautifully and thoughtfully written, and you won’t soon forget the people that you meet throughout. The stories and ideas are elegantly woven together. I will certainly be checking out the author’s other books.