Between the Lines - Being Mortal

March’s Pick - Being Mortal, by Atul Gawande

Thoughts
In Being Mortal, Atul Gawande writes that modern medicine has made an “experiment of making mortality a medical experience” and “the evidence is it is failing.” The problem is not of course that doctors can’t fix death, the problem is that with the tremendous gains in medical technology death can be staved off oftentimes at the expense of real life for the patient. What was once in the hands of family is now in the hands of doctors and institutions. Increasingly, the last days of our lives are spent alone, isolated in nursing homes, intensive care units and hospitals enduring invasive treatments, and on mind-numbing drugs. Gawande fears that the medical community inflicts harm on the very people they set out to care for, and he wants to understand what happened. He writes about how a society that values independence doesn’t know what to do when independence gives way to dependence; frailty is not an illness, but it is treated as such. You will learn how nursing homes and assisted living facilities came into being and how their residents traded their autonomy for safety. On a brighter note, you will be introduced to caregivers who are doing things differently at great success for their residents. Through his moving portrayals of patients you will no doubt gain insight into how to navigate the complexities of end-of-life care for your loved one when the time arises. He asks how we can age well and live fully when we have limited time. I loved this book with its poignant stories. The clarity and wisdom found here has given me courage I did not think I possessed to accept the inevitably of death, and it has done so by reminding me what a gift life is.

One last thought - If the goal is to support the highest quality of life possible for whatever time remains then we learn in Being Mortal that we need to ask a new set of questions, and they are as follows:

1. What is your understanding of where you are and of your illness?
2. What are your fears or worries for the future?
3. What are your goals and priorities?
4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?
5. What would a good day look like?

 Overall
I strongly recommend reading this thought provoking and important book. Aging and death are topics that most of us avoid discussing, in spite of the fact that we know that the realities of aging and death are inescapable. What makes Being Mortal an invaluable read is that in the midst of the difficult questions surrounding death, better questions about what makes a good life are raised. What emerges is a clear and rich picture of life: what gives our lives meaning, and what a good life looks like. The extent to which our medical system, our communities and our families help those facing the finitude of life meet their individual goals will be our measure of success as we strive to do what is most essential and compassionate.

P.S. I just learned that Frontline, the PBS documentary series, made a film based on Being Mortal. The documentary follows Dr. Gawande as he investigates the American medical profession’s care for the dying, specifically the relationships doctors have with their patients who are nearing the end of life. You can find it here. I was delighted to discover this documentary and will definitely watch it, but please don’t skip the book.

Kathryn