Being mortal : medicine and what matters in the end

by Atul Gawande

Hardcover, 2014




New York : Metropolitan Books : Henry Holt & Company, 2014.


Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families of the terminally ill.

Media reviews

His new book, “Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death. It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.”

User reviews

LibraryThing member kidzdoc
In Being Mortal, Dr. Atul Gawande turns his attention to the way in which we die in advanced countries has changed over time, from a natural process at the end of life that took place in the home, surrounded and comforted by loved ones; to an artificial prolongation of life in hospitals, in which patients are subjected to futile and expensive care but often suffer terribly in their final days; to confinement in nursing homes and assisted living centers, where residents' independence and decision making capabilities are frequently overridden by policies to ensure their safety and compliance with staff; to a nearly full circle return to a good death in the home with the help of family and palliative care and hospice specialists.

Gawande uses his experiences with the terminally ill as a medical student, surgeon, independent observer and son to effectively illuminate the points he makes and the lessons he has learned, which transforms [Being Mortal] from a dry treatise with limited usefulness to a valuable and necessary work that individuals, families, health care providers and policy makers will benefit from and easily relate to. He allows the afflicted and those who work with and care for them to share their stories as well, which provides the reader with more insight and clarity.

One of the most important lessons for physicians in Being Mortal, and the one that had the greatest impact on me as a hospital based pediatrician who routinely cares for incurably and terminally ill children, came to Gawande from the individuals and medical staff that he interviewed and the literature that he read in order to write this book. Too often the focus of the care of the dying is on what medicine can do for the patient: surgeons can operate to remove or debulk a tumor, oncologists can try yet another chemotherapeutic agent when others have failed, and hospitalists and intensivists can provide antibiotics, oxygen and other supportive measures to manage a current crisis. Unfortunately, these interventions frequently do not reverse or improve the primary illness, and the patient is either left in a more debilitated state than he was before, suffers from severe side effects from these treatments that can be worse than the illness itself, or both. Instead, the focus should be on what the patient wants in his remaining days instead of an all out, scorched earth effort to achieve a cure, and how his medical team and loved ones can help him achieve his goals and make him comfortable and lucid as the end nears. Only by asking and listening to the patients and family will this information be learned, and in doing so the physicians and other medical staff can provide the services that are most needed.

As a physician, a son of elderly parents, and a person contemplating his own mortality in middle age, I found this to be one of the most important books I have ever read, and it is one that I will turn to time and again to remember the wisdom contained within it. Being Mortal should be read by everyone, and I thank Dr. Gawande for sharing his own experiences, failures and successes with us in writing this essential work.
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LibraryThing member Whisper1
This is a book I finished last week, and like it so much that I am practically telling everyone I've talked to since then to read it.

It is incredibly well written, well researched and very thought provoking. As a surgeon and physician Gawande covers quite a few topics, including end of life issues, homes for the elderly, the health care system, and the decisions that must be made before it is too late to make them.

Some of the comments were those I could relate to, including the fact that this time when I had surgery, a number of the nurses and doctors called me "honey!" This made me realize that society is looking at a 62 year old and thinking I am old! I don't think of myself as old, but I do know I am the generation of the baby boomers, and we are the ones that are starting to impact on health care and insurance coverage costs. One of the head surgeons looked at me and said, "Hey, you are 62, but you don't look old!" His tonal comment indicated that he perceives 62 to be someone who is elderly.

And, as a friend one said, we will probably be the first generation to be buried without our original body parts. We have knee and hip replacements, teeth with fillings, and in my case, three neck fusions and now rods and screws throughout my entire spine. Luckily, I'm young enough to make the decisions regarding difficult surgeries. But, as the author stresses, many as they grow "OLD" might not have that luxury, ie either a health care system or family will make the decisions for them.

Of particular interest was the author's research which indicates that fewer people are studying geriatrics, or choosing to work with the elderly. Already there is a shortage of doctors in this field, primarily dictated by the fact that the elderly take much more time during an office visit, and this is time insurance companies are not readily agreeing to reimburse.

If then we look to the future, knowing that already there is a shortage in these fields, what will happen to the baby boomer generation, now living longer?

The author is very frank about our rights at the end of our lives to make clear decisions regarding what we want to do should we be in a situation such as end-stage cancer and the fact that conversations need to occur openly, honestly and to listen to the one who is dying and to respect their wishes.

Is chemo worth the time it robs from living our last days? Does the one riddled and ravaged with cancer have the right to say no to chemo and to be heavily medicated instead? Can the family allow the grace to respect wishes? Can doctors who are trained to heal at all costs be re-trained to be able to have frank conversations with their patients regarding prognosis, risks and choices? Can we as a society have a sea change in the way in which we look at the end of our days and be clear regarding how we want to live them.

There are chapters regarding assisted living homes and lots of information regarding what concepts work for the elderly, such as individual rooms and pets at the facilities opposed to having a stranger for a room mate, separated by a sheer curtain, when all your possessions are now on a shelf in a closet. It made me realize that I find tremendous comfort in my books stacked throughout the house and the feelings I would have if I could no longer have them.

This is an incredible, very thought-provoking book. I highly recommend. While it deals with very heavy issues, I did not find it depressing. Rather, I found it an incredible, honest look at the natural aging process and the right to live with respect.
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LibraryThing member jeff.maynes
Atul Gawande's *Being Mortal* is an excellent book that combines a powerful reflection on our behavior and ideas about care for the elderly, with a personal touch that brings broader questions to the reader. In the book, he explores the central conflict he identifies at the heart of our well intentioned, but harmful treatment of our elderly. Or, perhaps, it is better classified as two central conflicts that are intertwined.

The first conflict is between the way in which we conceive of the role of the physician and the needs of the elderly. The physician is understand and trained as an expert on the mechanisms of the body, and not of the value-based decisions that are involved in end of life care. After all, the argument goes, values are deeply personal, and physicians cannot be experts in them. Yet, Gawande argues, this merely leads us to train our physicians and arrange our medical institutions to aim at the extension of life even at the expense of these other values. The physician is focused on the patient's condition as a problem, and not on relating to the patient. The care that results, he argues, is not responsive to the situations or needs of the dying.

The second is between the role death plays in our lives and the ignorance with which we approach it. We are unable and unwilling to have conversations about what life we would like to lead as we enter our final stages, and when we would like to die. The result is that we are ignorant, not of our medical conditions, but of our own values. We do not know, and our caregivers do not know, what care will actually respond to our needs and desires, since they do not even know our needs and desires.

The two combine in powerful ways, for the lack of communication between physicians and their patients underlies and exacerbates patient ignorance. Similarly, the expectations that power of modern medicine places on the family and friends of the dying similarly constrains those at the end of their life. They have no direction to turn to have these deeply difficult and important conversations about what we want the end of our lives, and our deaths, to look like. This, in turn, leads us to pursue means that prolong life without careful consideration of what we are prolonging. This fuels the dominant physician model, and the problems are deepened.

With Gawande's background as a physician, his insightful consideration of philosophical questions and his clear writing style, I found this to be a delightful meditation on these abstract questions about the ways in which we understand physicians and their role in providing care. It raises a number of fascinating questions, and explores them in sophisticated ways without sacrificing readability. I would use the book, or portions of it, in one of my Bioethics, or applied ethics classes.

It is also deeply moving with a personal touch that helps the reader engage with the text in not merely a philosophical/medical/social way, but in a deeply personal way. Gawande deftly weaves personal stories throughout each chapter, unveiling the central stories of each bit by bit as they fit the theme of the chapter. Thinking over these cases naturally led me to reflect on the people I know and care about, and about myself.

I found this to be a sophisticated and powerful book, but one that is by no means dry, stuffy or difficult to read. Gawande's prose is easy to read, and the ideas are presented in such a way that he is leading the reader to think through the deep issues. I highly recommend this book for any reader who will one day face the decisions of death and dying - and it should be obvious by this that I am extending this recommendation widely indeed.
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LibraryThing member sallylou61
Being Mortal is an excellent book which examines the situations which people can encounter near the end of life. Dr. Gawande discusses both the environments in which people can live as they age, and also the medical treatment which they can and should receive. Many older people want to live at home as long as possible. However, often at some point, they need more care than they can get at home. He points out the problems of nursing homes in general as being institutions stressing safety instead of the quality of life of their residents, and discusses the trend toward assisted living facilities which can have some of the same problems. Dr. Gawande paints a much more positive picture of hospice care as being a source of help for very ill patients and their families when the end of life is near.

Dr. Gawande also examines the role of medicine for patients near the end of their lives. He emphasizes that doctors should find out what terminally ill persons want instead of doing heroic measures which may keep the people alive longer but often in great pain with a poor quality of life. He discusses the different approaches doctors use, and advocates that doctors work with patients and their families work to determine the proper treatment for the patient to live as fully as that person can. Although the emphasis is on the elderly, one of the many stories told as examples concerns a young, newly married woman who has her baby after becoming terminally ill.

This review is based on the advance reader’s edition and does not include the acknowledgments or index, and the endnotes are not numbered nor are their presence indicated in the text.
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LibraryThing member cameling
As with Complications, I am grateful that Dr Gawande has the humility and passion in allowing us into understand the personal doubts, challenges and discomfort those in the medical professional sometimes face when dealing with patients who are facing end of life brought on by terminal illness or the natural wearing down of the body due to age.

I've never given much thought prior to reading this book, about palliative care, hospices, assisted and independence living options that could and should provide people with a less stressful path to the end of their earth-bound lives. I'd not given any thought to how and what I might possibly want if I were in the situation where I could no longer take care of myself. But now I do. Now I have an idea of what I might want to look into, just as something to plan for before it becomes a desperate necessity. Dr Gawande's book has at least set some basic groundwork for me to work on.

His case studies are compassionate but pulls no punches. We're introduced to people and their families who have to are determined to hold on to their lives regardless of cost and the pain they'd have to endure to do so, in addition to others who are equally determined not to go through procedures that may prolong their lives if it means they need to give up aspects of their lives that are more important to them.

Discussions of death and how far one should go in treating terminal illnesses are never easy, not only between doctor and patient but between patient and his/her family members. But if there's one thing that has been made blatantly clear to me in reading this book, it's that it is a very important discussion that must be held if one is to ensure that one's own wishes are to be upheld when one reaches the point where one may not be in a position to determine the next course of action.
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LibraryThing member RidgewayGirl
Atul Gawande's newest book is about those topics that we'd really rather not discuss until we are forced by circumstance to do so, at which point we are no longer in the best place to make the right decisions. How we'd like to die, how we'd prefer to be cared for when we are old enough to need help with our daily lives, and what standard of living do we need in order to make living worthwhile, are all questions Gawande raises and then looks to various institutions, doctors, medical personnel and the people and the families most affected for answers.

There's a lot of information in this book. As the child of aging parents, what I took out of it is different from what my father did, or that any other person would, depending on where they are in their life's journey. My main take-aways were learning which questions are important to ask, primarily in determining what my parents want at each point along the way. It's not really important what I see as the best thing to do; and when parents age and aren't perhaps as sharp as they once were, it's easy to take over decision making. Doctors are also prone to pushing medical procedures that may prolong life, but at the cost of the person being able to enjoy the time they have left. Gawande looks at whether people prefer to live longer, or whether they prefer to live for a shorter time, when that extra time is spent in a bed, unable to do the things that once brought their lives meaning. We all have a story, he says, and we need to be able to shape that story to its end. He looks at how our desire for safety has made the elderly less independent, and our desire for our parents to receive the best possible care takes away our parents' privacy.

Gawande takes us through the experiences of various people, and how the decisions they made, or that were made for them, made them happier or reduced their independence. He also looked at some new ideas in how to care for the aging and what has had an impact in making people content with where they are.

This is an important book, especially for anyone with aging parents, or who are aging themselves. We may not need the lessons learned in Being Mortal yet, but the more we discuss and plan for the future now, the easier it will be.
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LibraryThing member bragan
Aging and death are things all of us have to deal with eventually, both in ourselves and in our loved ones. But, physician Atul Gawande says, these inevitabilities are often much worse than they actually have to be. People frequenty fail to communicate, or even consider, their end-of-life wishes until it's too late. Aggressive treatments for terminal diseases or measures aimed at providing safe environments for the infirm may end up making people's lives worse, rather than better. Few doctors are specifically trained in the care of the aged, and most begin their careers unprepared to deal with the dying. Above all, both doctors and patients are programmed to see healthcare purely in terms of identifying and treating specific medical problems... Which works well when your problem is a broken bone or a case of strep throat, but less so when it's an incurable cancer, or the general, systemic decline that comes with age.

That might make this sound like some hippie holistic-medicine manifesto. (You know the kind of thing: "Forget all the reductionist Western medicine, man! You've got to, like, treat the spirit with positive energy!"). It's absolutely not. Gawande's approach is very much grounded in medical reality, and he's got some actual science on his side. (E.g., the study that concluded that, counter-intuitively, terminal patients placed in hospice care actually lived longer, on average, than those who aggressively treated their conditions.) This isn't primarily about science and statistics, though; throughout the book, he focuses on real human beings and how they, their doctors, and their family members deal with infirmity and death, in all their awful complexity. This includes stories of his own family members, some of which must have been incredibly difficult to write about, but which I think are invaluable in helping the reader to connect to these issues on a human level.

His conclusions, ultimately, are ones that make a lot of sense to me: Doctors should be better prepared to deal with these concerns and to talk honestly with their patients about them. Everyone should have the difficult discussions about their end-of-life wishes ahead of time, especially those with terminal illnesses. Nursing homes should think of and treat the elderly less like hospital patients and more like people who need help to live lives that still have meaning. And doctors and patients should together consider not simply the question of what actions might help to shrink a tumor or prevent a broken hip, but on how to maximize the overall well-being of the person, given their individual priorities for what matters to them in the time they have left.

I was honestly a little reluctant to start this book, fearing it would be entirely too depressing. And I suppose it is, a bit. Aging and death are sad and scary subjects, and some of the stories Gawande tells are heartbreaking. (The descriptions of miserable, hopeless people in nursing homes particularly got to me. Being a woman with no children and meager savings, I fully expect that will be me someday, and the thought is terrifying.) But the book itself is hopeful, with genuinely useful suggestions for how we can make these things easier, both individually and as a society. And the writing is utterly compelling. It seems very odd to say "I couldn't put it down" about a book of this kind, but it's true. I couldn't. I ended up reading it all in less than a day.

Rating: A book this good about a subject this important surely cannot receive anything less than a 5/5.
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LibraryThing member Narshkite
Brilliant, informational, and honest. It is amazing that hearing that autonomy matters, often more than safety, in the treatment of our infirm elders is revolutionary, but for me it was. I never really thought about it with my own father. We needed him safe, that as our only concern. And from the day we put him in assisted living he did nothing but pray for death. There were many other things that led him in that direction, but that loss of autonomy was at the top of the list. And it seems so common sense. I have often said that I want the right to die if I lose the ability to take care of myself. But when it came to caring for my father I never gave it a moment's serious thought. Gawande is always exceptional, but with this book that combines research and reporting with the crushing and personal story of his own father's death and dying, he redefines the genre. A must read for everyone.… (more)
LibraryThing member Sean191
Atul Gawande makes me envious. He's an accomplished doctor and a talented writer. Somewhere, someone in the world is short on talent because he's got the extra.

Anyway, Being Mortal is a must read. It's a look at aging, a look at medical care for terminal patients and a discussion about when enough should be enough when trying to keep people alive. It's a question of quality over quantity when it comes to final days and Gawande explores the question tactfully and brilliantly.

In all honesty, I can say this book may have changed my life since I'm reevaluating my career choices in part because of aspects of health care that Gawande discusses here.
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LibraryThing member jmoncton
Modern medicine has made amazing advances, extending people's lives and eliminating some diseases. But in the end, we are all mortal, and sometimes there comes a point where the best course isn't another experimental drug or another round of chemotherapy. An excellent book, heartfelt yet practical, that raises important issues about what really matters in life. A MUST read for doctors and patients.… (more)
LibraryThing member SqueakyChu
After going into sudden and unexpected retirement and then seeing some of my closest friends' parents physically deteriorate and then pass away, I much appreciate the thoughts expressed in this book. It expresses concerns for how systems we have in place now for housing and health care for the elderly are not always in their best interest.

The book begins with concerns about loss of independence in the elderly and ends with loss of life. People live longer now than they did two centuries ago and have easier access to aggressive medical care which may further prolong life. New ways are being developed to provide safe housing for the elderly, but it's just as important to address their psychological needs. Impending death, likewise, should not merely be concerned with prolonging life, but it should also address quality of life.

Atul Gawande talked about his father's illness and death while revealing which actions worked in his family and which didn't. He shared his experiences in order for readers to think personally ahead of time about what we expect for ourselves and those we love as we age. To sincerely listen to the desires of our elderly and to put those desires into action is the most important message of the book.
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LibraryThing member janey47
I can always count on Atul Gawande to present important questions in a way that is carefully considered and yet very accessible. It's no coincidence that he's so highly regarded in so many circles.

When I learned about this book, I was really excited, because I'm a fan of his and I'm also very interested in end of life issues. I've been a hospice volunteer off and on for years and I've seen the landscape change dramatically since the 80s, when I first started looking into it. Even so, in the first part of the book, I found myself anxious and disturbed, because now that I'm in my 50s, I see true old age looming and I'm fearful of all the many things he describes -- infirmity, loss of independence, meaninglessness. It hit so close to home for me that there were moments when I thought, "I can't finish this book." Whenever that happened, I reminded myself that Gawande always presents solutions, and they're always closer to being in reach than we might have thought. So I read on.

I'm glad I did. He's a treasure. I'm glad he's writing, because he's raising awareness of all kinds of important issues among lawmakers and individuals like myself. His writing style is incredibly accessible. This is a must read.
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LibraryThing member jnwelch
Being Mortal by Atul Gawande is one of the best books I've read, period. The first thing I said to my wife after finishing it is, this book is un-effing-believable. Then I repeated that a few times.

It's wise, moving, insightful, heartbreaking, heartwarming, heartgrowing. It's about dying. It's about how we practice medicine (often wrongheadedly), how we should practice medicine, when we should not practice medicine. It's about what's important in our lives, how we want our story to read, how we want it to end. How we want it to be for those we love who are nearing the end, who are at the end, for ourselves at the end.

"{O}ur decision-making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussions were an experimental drug, the FDA would approve it."

"{Y}our remembering self is attempting to recognize not only the peaks of joy and valleys of misery but also how the story works out as a whole. That is profoundly affected by how things ultimately turn out. Why would a football fan let a few flubbed minutes at the end of a game ruin three hours of bliss? Because a football game is a story. And in stories, endings matter." Including the stories of our lives.

Bring some kleenex - for the happy stories, for the stories when things are done right. What questions should we ask, what goes into solid decision-making? Gawande does his homework, going to facilities, and talking with patients and doctors and specialists, including palliative care practitioners and geriatricians. He cites the results of critical studies in plain English. He looks at failures, including some of his own, and what goes into creating a success. He painfully but successfully applies what he has learned to his patients and to the distressed health of his own father.

We've been wrong about what our job is in medicine." Read this to find out why. What an extraordinary book. Un-effing-believable. Five stars.
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LibraryThing member detailmuse
{...O}ld age and infirmity have gone from being a shared, multigenerational responsibility to a more or less private state -- something experienced largely alone or with the aid of doctors and institutions. {...} This experiment of making mortality a medical experience is just decades old. It is young. And the evidence is it is failing.

In a nursing home, the official aim of the institution is caring, but the idea of caring that {has evolved doesn’t} bear any meaningful resemblance to what {some} would call living.

I’ve been looking forward to this book since I read what became a chapter of it -- Gawande’s New Yorker essay, “Letting Go” (Aug 2, 2010). Of several similar books I’ve now read as my parents aged into their nineties and died, and as I age well into middle age, this is absolutely the best.

Best because it addresses the big picture. First, what makes life worth living? Almost always, the answer includes a desire for even fragments of independence and quality of life, not necessarily length of life. Second, in the face of a growing mortal blow to that life, which care/treatment options point toward what you desire vs. away from it? Often, that answer then obviates the need for ponderous research into life-lengthening caregiving and therapies.

Gawande begins with independent old-age and then explores decline; caregiving (family; and the creation of senior living spaces, assisted living, and nursing homes); life-improving vs. life-lengthening healthcare interventions; and hospice. Throughout, he’s philosophical, informative and poignant, in a combination that inspires inexplicable optimism. Highly recommended.… (more)
LibraryThing member parker
This compact book piercingly first explores modern models of aging. Dr Gawande ostensibly reviews the development of nursing homes as an extension of hospitals and assisted living communities as a response to the abject failure of institutionalized medicine to assist the elderly and progressively frail, but in so doing, he delves into the what gives life meaning when time becomes limited and ability wanes and also discusses how our loyalties and individualism interact with our needs for food, safety, and shelter throughout our lifespans.

Then pushes into modern concepts of dying and of the importance of "authoring our own story" up to the end of our lives and the importance of talking about living well, especially near the end of life, rather than about "dying well." This section of the book is emotionally charged and will likely provoke a range of reactions. He discusses some of the medical literature demonstrating that treatments and interventions directed at "curing" one specific disease in an already debilitated patient may shorten, rather than prolonging, life in addition to the more widely recognized side effects and adverse effects on quality of life associated with "aggressive" chemotherapies and surgeries. These concepts do not extrapolate well to all situations and everyone's death, even from similar disease, is unique, so that the challenge of talking about and planning a good life in the face of impending but still uncertain death is enormous. Every physician and indeed every loved one of a dying patient knows this, but as Gawande points out, we only die once, which doesn't allow for practice.

Our training in medical school currently presents two models of the patient-physician relationship, one older paternalistic model ("The physician knows best") and one newer retail model ("The consumer is always right"). A third way, suggested in the later chapters, of an interpretive patient-physician relationship may more realistically meet the challenge. Several stories of patients and his own family members (grandparents and, poignantly, his father) illustrate and humanize the narrative.

More depth in the patient-physician relationship would have been appreciated. Also the argument for death on its own time because of the importance of the "dying time," the phase of life where many of us consolidate some of our lives' lessons into wisdom for future generations, either as legacy planning or more intimate one-on-one "farewells", also seems to deserve more attention.

Throughout, what I thought of most was how perfectly this book responds to the first aphorism of Hippocrates: "Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult."
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LibraryThing member mdoris
Finished [Being Mortal] last night and I thought it was excellent. It is done as a series of essays and there is a direct approach for "telling it like it is" for end of life concerns (housing supports) and choices and challenges in choosing treatments and/or palliative care. It is well written and very personal and self examined as the author is a surgeon so he is in the front lines. Of course it is a tough read as it tells the stories of individuals parting from this world. It feels like a very timely and appropriate read though with discussions that our culture struggles with so much. It's time to talk and to learn how to talk about these critical matters,… (more)
LibraryThing member froxgirl
Maybe if you don't have elderly relatives or friends, or have not suffered from a chronic disease, you can bypass this book. If you do, you'll regret missing such a clear-headed analysis of deciding how to live if you know the end of your life is approaching.

It's likely, of course, that all of our "DNR" orders and "good death" resolutions will disappear when we are confronted by the spectre of only a few weeks or months left. Dr. Gawande, a surgeon at Brigham & Womens, tells us that most patients in that horrible place cannot comprehend just how brief their time left has become. We all seems to think we've got ten years left until a doctor finally gathers the courage to stop leading us on with false hope and tells us the truth. If the doctor ever does! Gawande's thesis is that doctors are not trained to tell patients news without no hope.

He offers hospice care as the alternative to surgery, chemo, radiation, etc, that offer no relief from pain and no hope of recovery. Based on studies he cites, people actually live longer with good hospice care, if they use it as a means of creating a better death, so to speak.

There is also a well written section on assisted living, and Dr. Gawande shares the saga of his own doctor father's death, during which, as son and doctor, he struggles with the same issues as he does with his own patients.

Very highly recommended. Will make you think and think hard.
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LibraryThing member papalaz
I was 11 when I saw my first dead body. Our neighbour died of lung cancer and his casket viewing was public. I even sat vigil with the corpse. More importantly, at least according to Atul Gawande, I had watched his end of life. Gawande, a surgeon at Harvard Medical School, has written a book (Being Mortal: Medicine and What Matters in the End) about end of life the reading of which I beg to suggest would relieve much suffering in all medicalised societies and especially in over-medicalised societies. It is not a book, you see, about death but is is about dying and how we manage or over-manage or mis-manage the process of dying: the end of life as Gawande would have it.

My neighbour’s end of life journey is in all likelihood one that is rarely seen these days. It took him a mere 6 weeks to go from diagnosis to coffin. I visited him during that time - he did not go to hospital to die. I bought him books from the library. I helped him with his crossword puzzles. I sat and talked with him although he spoke less and less as the cancer progressed and choked him to death (that’s how it seemed me at the time). There was no surgery, the x-rays that produced the diagnosis ( a public mass chest x-ray screening in a mobile x-ray unit outside the local pub) convinced the doctor and the family that cutting him up as it was then known would do nothing to stop his death coming for him. He had pain control and he had his family around him and he had the reassurance that it was not going to take very long. He had a good end of life and that is a rare thing these days.

Gawande has looked at modern ends of life and suggests several quite simple changes we could make that would make many more ends of life good - simple and, once pointed out, obvious. I’ll not reveal them here in an attempt to tempt you to read the whole thing. I had thought that this book would be all about old age and nursing homes and the pointless prolonging of life and while Gawande covers all of these things he covers what we would now think of as premature ends of life as well and he does it without unnecessary statistics and with humane anecdotes of real ends of life. He is not coruscating about the failures that we have introduced into a totally natural process because he understands how and why these things have happened but he has the sense to stand back and observe closely. What I found most enlightening was to get a medical man’s perspective on the whole journey: it seems that even hardened medicos are uncomfortable discussing actual death, preferring to engender hope rather than reality. In fact I think that doctors should be made to read this book. Mind you, I think everybody should read it. If you think you might die one day, and even if you don’t, YOU should read this book.
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LibraryThing member markwhiting
LibraryThing member MidnightRose966
This is an excellent book for those of us growing older, and who have aging family members. I learned a lot about why assisted living and nursing homes were created, and the differences between them. We all want to stay at home until we take the final step in living, but for some people that goal is unattainable. This book is a good introduction to having conversations with loved ones about what they want, and what we want for ourselves. Talk things over before you are faced with making decisions for someone unable to make their own. Discuss what facets of living someone really finds important and research ways for them to hold on to those things. What we find important varies and giving a person as much autonomy as possible extends their happiness and quality of life. I've already recommended it to several people and will continue to do so.… (more)
LibraryThing member russdaniels
Must read--in that it should be mandatory. The part of living that most people today get wrong. If you are a parent of an adult child, or an adult child with a parent, you both need to read and discuss this book. Most people most value autonomy for themselves and safety for their loved ones. When you have to decide for a loved one, or have one decide for you, the odds of it going horribly wrong go down if you sort it out first rather than waiting for the inevitable gut-wrenching crisis.

Gawande does a great job of telling stories while communicating evidence and experience-based information.

Read this book.
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LibraryThing member larryerick
This is the third book that I have read by this author, and I will certainly look forward to anything he writes in the future. He always offers a clarity and intelligence to everything he presents. This is perhaps his most personal work. In fact, this is really two books in one. The overall theme of the book is about how the health care industry handles the aged and dying. The author summarizes his focus well: "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." The first half of the book concentrates on how our rapidly increasing senior population is offered poorly matched services, some of which actually hurt more than help. It presents examples of significant improvements that have failed to be promoted well, in great measure because the profit motives are elsewhere. The second half of the book is much more personal and about end-of-life measures, primarily for oncology patients, but which could apply to almost anyone. While both parts of the book fit under his theme, it is not unreasonable to think this could have been two standalone books fleshed out even more. He makes a great case for meaningful work in this area, regardless. Well worth reading for anyone facing their senior years or anticipating future involvement with someone who is.… (more)
LibraryThing member mjlivi
This is a book that's hard to read for the very reason that it's essential - it tackles a topic that our society really struggled to talk and think about in any depth. Which is because it's grim, scary and confronting obviously, but Gawande demonstrates that this failure to really think about how we age and, yes, die means that more and more people are having unnecessarily awful experiences at the end of their lives. The balance between medical treatment to extend life and that to improve quality of life is the key issue, and Gawande illustrates it clearly and movingly, using heart-breaking anecdotes and an array of research to make his points. You'll find yourself worrying about your own ability to deal with the difficulties that are ahead of us all, but that's the whole point - none of this gets easier if we just pretend it isn't going to happen.… (more)
LibraryThing member nyiper
I really would have given this 10 stars. Gawande is remarkable in his ability to make things clear. In an interview he claimed that his family and other readers kept telling him that he was boring here and there, etc. The stories he brings in make the subject all that more real and I can say that not only should everyone read this---it needs to be absorbed and used immediately---and with that....I'm working on it!!!… (more)
LibraryThing member greeniezona
This book has been on my shelves for ages, since Book Riot Quarterly included it in one of their boxes. Then a few months ago my friend recommended it. When my new doctor had me fill out a Five Wishes form and I spent a couple of days thinking about end of life decisions, I knew this had to be the next book I read.

This book was exactly what I wanted at that moment. Really a quite thorough introduction to end of life care -- starting from why modern medicine is sometimes so ill-equipped to deal honestly or well with end of life, then running through several strategies and fixes people have attempted to make end of life more humane -- what was successful about them and what were some of the obstacles they faced, especially in bringing these solutions to the culture at large.

Told through several examples of real people, the book also scaffolds what end of life decision making processes look like -- with input from the person dying, their family, and their doctors -- giving all sorts of examples of how to go through this process from any of those roles. Certainly no one looks forward to making these decisions for themselves or for a loved one, but I feel like just from reading this book I will have more ideas what questions to ask, what possible options to look for, and to be more ready and open to the conversations.

One of those books that truly, clearly needs to be more widely read.
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