Gawande, Atul, Being Mortal: Medicine and What Matters in the End,
New York, Metropolitan Books: 2014. 282 p.
I saw this book mentioned in a blog post a while ago and requested it through my library. When it arrived last week, I had forgotten that I had requested it. I finished it in about three days.
Gawande is a second-generation surgeon and writer. He came to realize that our medical approach to aging—focused on safety and treatment—does nothing to address quality of life. In the book, he examines nursing homes, hospice, assisted living, and medical treatments to battle terminal conditions.
He is a talented writer and his ability to tell a compelling story makes this book worth reading apart from the importance of its subject. The reader is introduced to a cast of real-life characters trying to cope with aging and illness. The stories are woven with love, hope, and sorrow. It gives the reader a view of what it means to be human and to be aging, ill, or both.
I have already devoted a fair amount of thought to this topic, having lost my mother to a rapidly degenerative brain condition in 2013. I wish I had read this book before that month, but after reading it, I have no significant regrets. My dad and I navigated the confusing, surreal month as best we could. The only thing that may have significantly changed some decisions would have been a clearer diagnosis, but that was not the hand we were dealt, and it was no fault of the medical team.
Of the many interesting observations in the book, one was the trajectory of end of life care as a society’s prosperity grows. At the beginning of the 20th century, most Americans died at home, merely because medical care (from our vantage point) was still primitive and not widely available. By the 1960’s, a large majority were dying in hospitals. Now in the 21st century, the trend is moving back toward the home. This is not because of a decrease in medical care, but an increase in the understanding of its limits. As Gawande observes in this book, death always wins in the end.
This is not just the detached observations of a professional in the field. The last part of the book follows the journey of Gawande and his father after a tumor is discovered on his father’s spine. He has skin in the game, and that is the real message of this book. In the game of life, we all have skin in the game—ours and that of those we love. We are foolish to not think about how our trips around the board will end.
Far from being a depressing book about death, I found it inspiring in many places and I would encourage everyone to read it. If I was in a position of teaching clergy or medical professionals, I would require them to read it. We have achieved the highest levels of health care this world has ever seen. Now, our challenge is to integrate it so that it contributes to our quality of life instead of detracting from it.