being mortal

Being Mortal Illness, Medicine and What Matters in the End by Atul Gawande

I think everyone should read this book. Everyone who might be mortal, everyone who may become old and frail. Everyone. I had been thinking that people in the medical profession should read this, especially those with responsibility for the care of the elderly. I still include them, of course, but this book is important to everyone.

“We've been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way.” ― Atul Gawande, (p259, 'Epilogue' , 'Being Mortal', Profile Books, ISBN 978-1846685)

In this book, Gawande explores how we look at medicine and what we expect of it. Our expectation has been that medicine is about mending things when they go wrong. This has reached the extreme of intervening with chemicals and radiation which have their own debilitating effects, cause great suffering and destroy the quality of life.

Death is inevitable. There is no complete cure. We’re all going to die. It’s helpful to understand that rather than live in the fantasy that we can be painlessly immortal. Once we understand that we can look at what we want to do with our lives and how much medical intervention we want, given that it may affect our ability to do anything at all.

The book looks at the institutions that we create to house the elderly and infirm. For me these have often appeared to be some kind of Waiting Room for Death, with nothing happening other than games, television and painkillers. No actual life.

“So this is the way it unfolds. In the absence of what people like my grandfather could count on—a vast extended family constantly on hand to let him make his own choices—our elderly are left with a controlled and supervised institutional existence, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about.” ― Atul Gawande, (p109, '4 Assistance' , 'Being Mortal', Profile Books, ISBN 978-1846685828)

The book looks at places which have taken the risk of bringing life back into the institutions. Places have introduced plants, animals and even children into the lives of their residents and thi shas had a profound effect.

“Gradually people started to accept that filling Chase [Memorial Nursing Home] with life was everyone’s task And they did so not because of any rational set of arguments or compromises but because the effect on residents soon became impossible to ignore: the residents began to wake up and come to life.” ― Atul Gawande, (p122, '5 A Better Life' , 'Being Mortal', Profile Books, ISBN 978-1846685828)

As well as these changes, the book looks at the possibility of making life possible for people in their own homes rather than institutions. This often goes together with giving up on major medical interventions such as chemotherapy and radiotherapy to allow people to live thor lives without the side-effects that these bring.

“The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. 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. Someone who understands that the damage is greatest if all you do is battle to the bitter end.” ― Atul Gawande, (p187, '6 Letting Go' , 'Being Mortal', Profile Books, ISBN 978-1846685828)

It is most important to be able to talk with your doctor about your preferences for treatment and what you wish to achieve in your life.

“In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.” ― Atul Gawande, (p177, '6 Letting Go' , 'Being Mortal', Profile Books, ISBN 978-1846685828)

In the end, medicine is about more than just survival.

“We've been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. ” ― Atul Gawande, (p259, 'Epilogue' , 'Being Mortal', Profile Books, ISBN 978-1846685)

The book intersperses academic facts and personal stories to create a powerful effect on the reader and brings home an understanding of life, death and medicine. Reading this will enable us all to make better decisions around the one aspect of life that is guaranteed for everyone: Death.