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

Reviewed by Noel Cheer and several reviews found on Wikipedia

Atul Gawande, MD, MPH, was born in Brooklyn, New York, to Indian Maharashtrian immigrants to the United States. Soon after they moved to Athens, Ohio, where he and his sister grew up and attended Athens High School.
He is a surgeon, writer, and public health researcher. He has been a staff writer for The New Yorker magazine since 1998, and has written four New York Times bestsellers about science.
In Being Mortal, 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.
An obsession with risk is stultifying the lives of the most vulnerable in our society, in the years when their choices should be most cherished and respected — even if those choices shorten their lives.
We have exalted longevity over what makes life worth living. More chillingly, Gawande shows how infantilisation of the old is promoted by profiteering companies. Building more compassionate institutions is not only straightforward, it costs nothing more, and the benefits in terms of improved quality of life are immense.
If the first half of his book concerns nursing homes and how we can age with self-respect, the second half concerns palliative care and how we can die with grace.
The intrusion of commercialised medicine, and the elevation of the interests of insurance companies over those of patients, can complicate these issues considerably, but Gawande remains clear-sighted through the muddle of anxieties, conflicting emotions and vested interests.
Towards the end of the book, he tells the story of his own father’s decline and death from a tumour of the spine. He finds doctors communicate most effectively when they jettison the position of detached, clinical observers and talk in terms of how they feel: “I am worried about your tumour because ... ”
Often the bravest and most humane decision, he realises, is to do nothing at all.
When time becomes short, Gawande has the presence of mind to ask his father: “How much are you willing to go through just to have a chance of living longer?” The answer helps guide his father to a relatively peaceful death in the arms of his family, as opposed to a technologised end in an intensive care unit.
Have we exalted longevity over what makes life worth living? And do we infantilise the old?
This is an original and moving exploration of illness and death.
The message resounding through Being Mortal is that our lives have narrative — we all want to be the authors of our own stories, and, in stories, endings matter. Doctors and other clinicians have to get better at helping people with their endings, otherwise more and more of us will end our lives babbling behind shining doors.



Quick links