I Wish I Hadn’t Read It; But I Want My Children To and Fast

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Being Mortal: Medicine and What Matters in the End

Atul Gawande, Metropolitan Books, Henry Hold and Company

New York, N.Y., 2014

I picked up this book when it first came out. It was highly recommended by one of the magazines I read. With the exception of books that I read to help me with my spiritual journey, this book has had more impact on me than anything I’ve read lately.  Here’s why.

Atul Gawande is a skilled writer.  His sentence structures flow easily.  Here is a medical doctor that is also very much skilled in the craft of communication. You will enjoy his honesty, his humor, and his ability to share difficult news with you in a way that has you saying, “Thank you, although I wish I had not known”.

Gawande admits that doctors today are wired to keep us alive and really have very little knowledge of how to let us die, seeing death in their patients as a failure. And this sets up the main foundational premise of his book as he writes, “Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things.” It is then up to us, our family, our medical team, to determine just how much and for how long we will fight this enemy.

Early in the book, Gawande introduces us to the concept that while they have the physical ability and the financial means, “the elderly have. . . chosen what social scientists have called ‘intimacy at a distance’.” This then provides the setting for most of us when we do get beyond being elderly and actually arrive at being old, no longer having our full physical capabilities to serve us well, and in many cases, not having the financial resources to buy that care.

Regardless of our personal circumstances, sooner or later, “ . . . independence will become impossible. Serious illness or infirmity will strike . . .And then a new question arises: If independence is what we live for, what do we do when it can no longer be sustained?” The author spends considerable time showing us how things fall apart with some real-life examples from his family and his patients.  You’ll see someone you know in one or more of them and you may even imagine, down the road, your parents, or worse still, as I did, yourself in one of them. Gawande says the problem is that more than half of the very old live without a spouse; have fewer children than ever before; and have given no thought to how we will really spend our last years.  Unfortunately, or fortunately, the latter will never be the case after you read this book.

As the author steers us to our second “dependence” stage of our life (the first one being our infant years), he also reminds us that we cannot rely on the typical nursing home to make it all bliss.  He writes, “They [nursing homes] were never created to help people facing dependency in old age. They were created to clear out hospital beds – which is why they were called ‘nursing’ homes.” He then goes on to explain the likeness between prisons and nursing homes and how while they serve one or more societal needs, they do not address “the goal that matters to the people who reside in them: how to make life worth living when we’re weak and frail and can’t fend for ourselves anymore.” Much of the book is spent in answering that question and he does so competently. That alone makes the book valuable reading.

He also points out that an adult child, when trying to find a residence for their aged parent, who asks, “Is this a place I would be comfortable leaving Mom?” is asking the wrong question.  What should be probed is, “Is this place what Mom would want or like or need?”

The book covers our search for autonomy and a better life in our old age, as well as when it’s time to let go and the serious and very difficult conversations and decisions that must take place at some point between and by parent and child, and between and by patient (and family) and doctor.  These are very insightful chapters. In the chapter on letting go he tells us, reminding us of his earlier premise that, “. . . 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.” And then he shows us how we can do that.

What I also found fascinating and very helpful was his description of three types of doctors a person can have – not so much in what they do for us, but rather how they arrive at what is done to us.  In a day when doctors seem to have a choice who to take on as patients, maybe it’s time we considered seriously who we want taking care of us or our aged parents.

The last chapter in the book is entitled Courage and it includes a line I found most memorable, “Assisted living is far harder than assisted death, but its possibilities are far greater, as well.”

In the Epilogue, using the death of his own father, also a doctor, as was his mom, and the ritual of sending him off, Dr. Atul Gawande shows us exactly what he means by “Being Mortal”.

This is a book very highly recommended for all who have reached the age where they get a senior’s discount, for all who have parents of that age, for all doctors who deal with aging patients, for all politicians, and all ministers or counselors. If I left anyone out, please forgive me. It was an oversight on my part and you can blame it on my age. 

-- Ken B. Godevenos, Accord Resolution Services Inc., Toronto, Ontario. 15/12/27  

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