Being Mortal: Medicine and What Matters in the End
by Atul Gawande
Metropolitan Books, 2014
"This is a book about the modern experience of mortality - about what it's like to be creatures who age and die, how medicine has changed the experience and how it hasn't, where our ideas about how to deal with our finitude have got the reality wrong."
Summary (from goodreads):
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.
Let me be very clear about this - Being Mortal was not an easy book to read. It challenged me to think about things I'd rather not think about. But I'm certain it will be the most important book I read this year.
It raises important issues about aging, death, and the role of modern medicine. Consider this:
"Medical professionals concentrate on repair of health, not sustenance of the soul. Yet - and this is the painful paradox - we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns. It's been an experiment in social engineering, putting out fates in the hands of people valued more for their technical prowess than for their understanding of human needs."It is important, for both physicians and family members, to remember that:
"People with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs..."That certain measures to prolong life may, in fact, be shortening or worsening whatever time remains often goes unnoticed.
Gawande suggests the posing the question, "If time is short, what is most important to you?" This could be the perfect starting point for a hard conversation with loved ones or a discussion with health care providers. It's a worthy springboard for deep soul-searching as well.
According to Gawande, as a society
"We've begun rejecting the institutionalized version of aging and death, but we've not yet established our new norm. We're caught in a transitional phase."And finally,
"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."Amen.
And I've only scratched the surface. There is so much worthy of discussion - with your spouse, your parents, your adult children, and even your book club.