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.
… (more)
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.
… (more)
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.
… (more)
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.
… (more)
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.
… (more)
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.
… (more)
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.
… (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.
… (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."
… (more)
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 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 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.
… (more)
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.
… (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.
… (more)
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 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.
… (more)
LibraryThing member annbury
This book has affected my thinking, and planning, about my own future, and about the futures of those I love. Our culture, as Dr Gawande stresses, makes it hard to think about the end of life, and hard to talk about it. That is in large part because we don't know much about it. Too many of us (including me, until I became an old lady) allow ourselves to expect a sudden illness, a short but steep decline, and a "Good Death" final scene, surrounded by loved ones and a sense of fulfillment. The deaths of parents and of friends, however, have taught me that death in our society is often prolonged, painful, undignified and lonely. Nonetheless, I still on some level hoped for the best, and didn't really think about what might lie ahead.

This book brings home to me that it is important for old people and their loved ones, and for other vulnerable individuals, to think about and talk about the end of life. In the first part of the book, Dr. Gawande shows that our system of warehousing the old if their care becomes too demanding is unkind, unhealthy, and extremely expensive. He explores a number of more humane and often cheaper approaches, focussing on the well-being and autonomy of the old person, not on safety as an absolute goal. Memorably, he says that we must allow the old room to make stupid choices. In the second part of the book, he focusses on the months and weeks before death. The medical profession, which tends to treat the illness rather than the patient, treats the diseases of old age as something that can be cured. Most often, Dr. Gawande observes, they cannot be cured. What is appropriate at that point is not acheiving the most hours and minutes of life, but the most meaning and understanding in life.

This is not the first book to discuss these issues, but it may be the most important. Dr. Gawande is a brilliant and sensitive writer, which makes his message much more vivid than it might be in other hands. Also, he is widely read, and widely admired. I hope this book has the impact that it deserves, and am recommending it to many of my friends and family.
… (more)
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.
… (more)
LibraryThing member RandyMetcalfe
End of life decision making, even end of life discussion, is fraught with emotional, conceptual, and therapeutic challenges. However, we mortals have been dying for tens of thousands of years (indeed, all mortals must), so this can’t be a novel occurrence even if, for Atul Gawande, the death of his father brought it front and centre for him. Indeed, the death of a loved one has a tendency to focus one’s attention. Even for a practising surgeon. It certainly got Atul Gawande asking some of the right questions and learning a few things that his medical education seemed to have left unexplored.

Gawande has two directions in his survey of the practice of death in America. On the one hand, he is concerned with the patient, the father or mother or wife or son who might be facing dire ends. How they meet their ends does matter, he thinks, and their ability to meet those ends largely depends on the kind of options available to them. But it also depends on the culture in which they live. On the other hand, Gawande is concerned with his own role as a physician. How doctors deal with death, and in fact how the medical establishment deals with death, is vital to the way in which our culture (call it a western industrial democracy) equips us to face our end.

Gawande is quick to decry the medicalization of death in America. Aggressive medical interventions keep many of us alive, at least in a technical sense, beyond our capacity to shape any further meaningful existence. Sometimes this leads to extended periods of debilitation or incapacity at the end of one’s life. Frequently that means stays of some duration in care homes of varying kinds. Gawande explores the history of these and sees progress, especially in the past twenty years, in refocusing such care towards resident autonomy and quality of life.

But extension of the period of decline, the period in which we might have need of care homes, only defers the more pressing problem that Gawande has in sight. The end is still the end, and reformation of care homes doesn’t change the challenge of how we and our doctors collectively meet that end. In the second half of the text, therefore, Gawande faces that challenge more directly. And this is when Being Mortal becomes more interesting. It is also, inevitably, more poignant. The various case histories that Gawande brings forth supplement the story about how his father, also a surgeon, met his own end. What remains puzzling, perhaps, is just how unprepared Gawande and his father and mother are when the questions they face are their own.

In the end, this is more a story about Atul Gawande’s developing humanism, his recognition that his medical knowledge is limited, and that he has more to learn, perhaps always, about how to live and act as a physician and as a human being. For those looking for a philosophically rigorous approach to death and dying, there are many other fine books available.
… (more)
LibraryThing member msbaba
“Being Mortal: Medicine and What Matters in the End,” by general surgeon Atul Gawande is a medical nonfiction book with a great deal of heart, humanity, and wisdom. This is the message at the core of this eloquent and compassionate book: when we are making medical decisions during a terminal illness it is best to focus on enabling well-being, not prolonging death.

I found the book fascinating and compelling; however, I was still disappointed. I wanted more analysis and more recommendations for political and societal change. What I got instead was a compelling set of human interest stories about people with terminal illnesses making medical choices that either prolonged their death at the expense of their well-being or the other way around.

I can easily see that this book would be an eye-opener for people who have very little or no experience with ushering a loved one through a terminal illness to their eventual death. I can also see how this book might be an eye-opener for people who have gone through a very negative experience with loved ones having their life prolonged at the expense of their well-being. But in my case, none of the stories in this book covered new ground. I have already traveled this road more times than most people would ever want to do in an entire lifetime. I know intimately what the slow downward spiral toward death is like in modern American medicine. I know about the frequent mistakes of prolonging life at the expense of well-being. But I’ve also learned much along the way, and I am now well-versed about how welcome palliative and hospice care can be for terminally ill loved ones. I know about the horrors of nursing homes and the shortcomings of assisted care facilities. I know about the benefits of being taken care of at home as much as possible and especially at the very end.

I thought this book would add to my knowledge of these matters. But it did not. It just increased my database of examples about what can happen to people as they face the many medical crises that occur while navigating the end stages of different types of debilitating terminal illness.

What was unique and beautiful about the stories in this book is that they were not just medical stories. They are stories that cover the full biographical, emotional, and psychological spectrum of people caught up in the crises of terminal illnesses. The author carefully discusses each major medical decision along the way and investigated how that decision contributed to, or subtracted from, the patient’s overall well-being. What was special was that the emphasis was always on the whole person, not on the illness.

I can understand how this book might be extremely useful for some people, but for me, it was not that helpful. For me, it was just a compassionate and beautifully written book about the state of death and dying in America at this time in our nation’s history. But I learned something that was heartening: there are many others like me. The affluent modern Western world is in a state of transition. More and more people are learning about the benefits of palliative and hospice care. More and more people are understanding the benefits of dying at home. More and more people are forcing their doctors to have difficult conversations about tradeoffs that might enhance their quality of life rather than prolonging their life. Many more realize that there is a better way to live while navigating the last, crisis-filled stages of life.

I recommend this book very highly to those who have not yet had much experience with all this. But for those of you who have already traveled this road, you do not need to relive it again with these stories…no matter how eloquently the author covers the subject. Instead, just get out and enjoy life. Treasure every simple everyday pleasure. Make your life about being happy in the moment. Life is short and very precious.
… (more)
LibraryThing member Clara53
This is a book about palliative care. But it's even more than that. It's about the choices people face at the last stages of life when confronted with terminal illness or very serious debilitation, and how it all can be helped - not to reverse the course of events (which is impossible) but to alleviate the torments to the utmost.

Not a cheerful read at first, but it's frank... And the more I read, the less I felt depressed about aging and problems associated with it. NOT because, like in much of popular literature, old age is hyped up to be the grand renewal of sorts. The author says that "people naturally prefer to avoid the subject of their decrepitude... Still, there are costs to averting our eyes from realities..." Because then, "we blind ourselves to the opportunities that exist to change the individual experience of aging for the better". And that's what the author is trying to establish - the reality of aging and mortality, how to face it and how deal with it in the best way possible, with quality of life in mind, as opposed to just with extending the quantity of days, weeks - which, prevalently, is the goal in the medical field these days.

Dr.Gawande describes nursing home concept (very failed experience in most cases, as he proves), assisted living (that originated so successfully in Oregon), and hospice at home that caters (if properly done) to each specific individual and is aimed at the quality of the ending phase of life. The doctors' job, he maintains, should not be just "to ensure health and survival", it should be "larger than that. It is to establish well-being. And well-being is about the reasons one wishes to be alive". It is even more poignant for the author - as he describes his own father's dying.

In conclusion, Dr. Gawande says that "...whatever we (as doctors) can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking."

I think everybody should read this book. The subtitle is "Medicine and What Matters in the End" - it pretty much says it all...
… (more)
LibraryThing member decaturmamaof2
this is a must-read!
LibraryThing member arubabookwoman
I finally got around to reading this widely-read and reviewed book. The subject matter is truly timely and important. I think I was expecting a book focused on medical powers of attorney, living wills, end of life discussions etc. These subjects were touched upon, but the book has a much broader intent. It stresses something I think I already subconsciously knew--that most older people want to live as independently as they can for as long as they can, and that many of our current nursing homes/assisted care living homes stifle the elderly's will to maintain their individuality and independence. There are movements afoot which interest me very much that enable our elders to live independently, but still be able to access assistance when they need it.

The other major point of the book is that in our modern era the care of the elderly has become entirely too medicalized, and this is not a good thing. Rather, the goal should not be strictly to ensure survival, but to "enable well-being. And well-being is about the reasons one wishes to be alive." Every person will have a different definition of "well-being," and we need to start having discussions (and deciding for ourselves) what quality of life or well-being will make our own life worth living.

Highly recommended.

4 stars
… (more)
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 anitatally
A must-read for anyone with aging parents.



Page: 0.3378 seconds