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
Thanks
for dropping by. Sign up to receive free updates. We bring you relevant
information from all sorts of sources. Subscribe for free to this blog or
follow us by clicking on the appropriate link in the right side bar. And please
share this blog with your friends. Ken Godevenos, Church and Management
Consultant, Accord
Consulting. And while you’re
here, why not check out some more of our recent blogs shown in the right hand
column. Ken.
It would be great if you would share your thoughts or questions on this blog in the comments section below or on social media.
