Being Mortal: Medicine and What Matters in the End

By | January 14, 2017
Being Mortal: Medicine and What Matters in the End


In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

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.

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.

An Amazon Best Book of the Month, October 2014: True or false: Modern medicine is a miracle that has transformed all of our lives.

If you said “true,” you’d be right, of course, but that’s a statement that demands an asterisk, a “but.” “We’ve been wrong about what our job is in medicine,” writes Atul Gawande, a surgeon (at Brigham and Women’s Hospital in Boston) and a writer (at the New Yorker). “We think. . .[it] is to ensure health and survival. But really. . .it is to enable well-being. And well-being is about the reasons one wishes to be alive.” Through interviews with doctors, stories from and about health care providers (such as the woman who pioneered the notion of “assisted living” for the elderly)—and eventually, by way of the story of his own father’s dying, Gawande examines the cracks in the system of health care to the aged (i.e. 97 percent of medical students take no course in geriatrics) and to the seriously ill who might have different needs and expectations than the ones family members predict. (One striking example: the terminally ill former professor who told his daughter that “quality of life” for him meant the ongoing ability to enjoy chocolate ice cream and watch football on TV. If medical treatments might remove those pleasures, well, then, he wasn’t sure he would submit to such treatments.) Doctors don’t listen, Gawande suggests—or, more accurately, they don’t know what to listen for. (Gawande includes examples of his own failings in this area.) Besides, they’ve been trained to want to find cures, attack problems—to win. But victory doesn’t look the same to everyone, he asserts. Yes, “death is the enemy,” he writes. “But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee… someone who knows how to fight for territory that can be won and how to surrender it when it can’t.” In his compassionate, learned way, Gawande shows all of us—doctors included—how mortality must be faced, with both heart and mind. – Sara Nelson

  • Being Mortal shares how we can better live with age-related frailty, serious illness and approaching death.
  • It is also a call for a change in the philosophy of health care from ensuring health and survival, “to enable well-being.”

3 thoughts on “Being Mortal: Medicine and What Matters in the End

  1. N. B. Kennedy
    917 of 957 people found the following review helpful
    5.0 out of 5 stars
    This book could be a game changer, September 23, 2014
    By 
    N. B. Kennedy (Hopewell, NJ USA) –
    (VINE VOICE)
      
    (TOP 500 REVIEWER)
      

    This review is from: Being Mortal: Medicine and What Matters in the End (Hardcover)
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    This book could be a game changer, if enough people read it and take it to heart. Atul Gawande addresses end-of-life care, and how we’re getting it wrong, both within the medical establishment and in our families.

    Dr. Gawande’s book focuses both on medical procedures and living conditions in later life. He addresses the reality that as people near the end of life, decisions about their living situation are primarily aimed at ensuring safety at the expense of retaining autonomy, especially when adult children are making the decisions. “We want autonomy for ourselves and safety for those we love,” a friend tells the author. We mistakenly treat elders as children, Dr. Gawande says, when we deny them the right to make choices, even bad choices. People of any age want the right to lock their doors, set the temperature they want, dress how they like, eat what they want, admit visitors only when they’re in the mood. Yet, nursing homes (and even assisted living communities) are geared toward making these decisions for people in order to keep them safe, gain government funds, and ensure a routine for the facility.

    In addition, Dr. Gawande shows how end-of-life physical conditions are most often treated as medical crises needing to be “fixed,” instead of managed for quality of life when treatment has become futile. Life is more than just a stretch of years; it must have meaning and purpose to be worth living, he says. This is a familiar concept (in fact, I read parts of this book in The New Yorker), but he builds a strong case for reform through case studies, stories from his own life, and examples of how individuals are either becoming victims of, or bucking, the system. He addresses assisted suicide only briefly, but he mentions it in relation to end-of-life care. “Assisted living is far harder than assisted death, but its possibilities are far greater as well,” he writes.

    The good news is that some people are doing what they can to improve the well-being of elders nearing the end of their lives. He demonstrates the beauty of hospice care in the home. He tells a great story of a doctor who convinced a nursing home to bring in two dogs, four cats and one hundred birds! It was a risky proposal, but the rewards were phenomenal. It made the place, and the people, come alive. I am aware, though, that these movements rely on individuals, and only if enough people have a vision for change will it come about. For that reason, I hope this book makes a big splash!

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  2. Miss Barbara
    542 of 573 people found the following review helpful
    5.0 out of 5 stars
    “The End Matters”, September 26, 2014
    By 
    Miss Barbara (Orange CA) –
    (TOP 500 REVIEWER)
      
    (VINE VOICE)
      

    This review is from: Being Mortal: Medicine and What Matters in the End (Hardcover)
    Vine Customer Review of Free Product (What’s this?)
    I became a fan of Atul Gawande upon reading his first book in 2002: Complications: A Surgeon’s Notes on an Imperfect Science. In reading many of his previous books I found he always asked questions: Why do we do things; for what purpose; is this working to achieve the best results for the patient in his physical and cultural circumstance? Gawande tackles the dilemmas of medical ethics by approaching them with sagacious common-sense. I think most of his books should be required reading in medical schools.

    In this new book Being Mortal: Medicine and What Matters in the End, Gawande looks at the problems of the aging population and inevitability of death. He points out that you don’t have to spend much time with the elderly or those with terminal conditions to see how common it is for modern medicine to fail the people it is supposed to be helping. In speaking of elder care he sadly points out that “Our reluctance to honestly examine the experience of aging and dying has increased the harm and suffering we inflict on people and has denied them the basic comforts they need most”. Many physicians are so hell bent on preserving life that they cause horrible and unnecessary suffering.

    Gawande points out that sometimes in striving to give a patient health and survival their well-being is neglected. He describes well-being as the reason one wishes to be alive. He looks at the “Dying Role” as the end approaches describing it as the patient’s ability to “share memories, pass on wisdom and keepsakes, settle relationships, establish legacies and make peace with their God. They want to end their stories on their own terms.” He feels that if people are denied their role, out of obtuseness and neglect, it is cause for everlasting shame.

    Gawande shares his deep seated feelings in this book by revealing personal vignettes of how friends and family coped with these powerful and challenging issues. He follows a hospice nurse on her rounds. He discloses how is mother-in-law Alice’s life is changed by taking up residence in a senior facility as the only reasonable option. Senior facilities and nursing homes, even the best run, are often sterile institutions that can cause psychological anguish. He includes how he dealt with the final wishes of his father. It is a melancholy yet empowering picture of a man and physician honoring his father.

    Atul Gawande provides the reader with an understanding that though end of life care is inevitable there are ways to humanize the process. The patients, their families, the medical professionals are coming to terms with how to better face the decision making processes that will be, in many cases, the last decision. The subject matter is complex and sensitive but the moral of the book is that “The End Matters”.

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  3. Katy Butler
    31 of 33 people found the following review helpful
    5.0 out of 5 stars
    Cool Jazz — Smart, Insightful & Dispassionate, October 8, 2014
    By 
    Katy Butler (Mill Valley, Ca.) –
    (REAL NAME)
      

    Verified Purchase(What’s this?)
    This review is from: Being Mortal: Medicine and What Matters in the End (Hardcover)
    Gawande’s style is like cool jazz — confidential and unhysterical in tone, far-ranging and penetrating in its insights –with big takeaways. 1. We have made a hash of end-of-life medical treatment, and cause unnecessary suffering by over-focusing on extending time rather than on human values, such as meaning and comfort, that often matter more to dying people. 2. We tend to want freedom for ourselves and safety for those we love — hence nursing homes and assisted living setups that rob their residents (inmates really) of autonomy, joy & purpose, even when well-run. 3. When a patient says, “Save my life, doc!” he/she usually means “restore me to my previous life!” (save my life, doc, not my mere body.) That is often impossible, and doctors (including, Gawande admits, himself) often choke on saying so. 4. Among the crucial 4 questions to ask a chronically/critically ill person: “what would a good day look like to you?”
    Gawande is an MD with an eagle’s overview of the medical landscape and a confidential, intimate writing style. His comparison of the death of his grandfather (in India, surrounded by supportive relatives, at 110, with no Hail Mary medical interventions) and that of his wife’s grandmother (alone in assisted living in the US) is poignant. He’s brilliant at painting the big picture with a light, seemingly effortless touch.
    In researching my own book, “Knocking on Heaven’s Door”
    (which explores end-of-life medicine from the vantage point of a daughter-caregiver,) I absorbed many lessons from Gawande’s award-winning work in the New Yorker, which forms the backbone of this book. Three cheers to Gawande for helping break through the confusion and terror surrounding medicalized death, and for highlighting the docs and nurses (especially in palliative care and hospice) working tirelessly towards a better way of death. PS Gawande would have a close-to 5 star rating, except for a one-star review from someone who doesn’t like “Obamacare.” I bet as the reviews roll in, this will balance out. This book will help reform medicine from the inside out and will be useful to all practicing physicians and health policy people. It doesn’t, however, “follow the money,” and that is a crucial shaper of poor end of life medicine. It won’t all be solved with better communication. Below, some companion how-to books I found useful as a family caregiver.

    Knocking on Heaven’s Door: The Path to a Better Way of Death Memoir and map, plus investigative reporting on the economic drivers of medical overdoing near the end of life.

    My Mother, Your Mother: Embracing “Slow Medicine,” the Compassionate Approach to Caring for Your Aging Loved Ones THE best manual for family caregivers of the aged, by the geriatrician who pioneered “Slow Medicine” in the US. Covers the last chapter of life — from first decline to what McCullough calls “Prolonged and Attenuated Dying.”

    Hard Choices for Loving People: CPR, Artificial Feeding, Comfort Care, and the Patient with a Life-Threatening Illness, 5th Ed. A hospice chaplain discusses when to stop pain-inducing medical measures from a practical and low-key spiritual perspective. Short and gentle, narrowly focused on end of life. Over 4 million copies in print.

    Can’t We Talk about Something More Pleasant?: A Memoir Hilarious graphic memoir of parental caregiving, by Roz Chast. Everything you felt but dared not say!

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