Though I haven’t read Atul Gawande’s most famous book, Complications, I read Better a year or so ago and found it compelling and thoughtful. As a result, I was intrigued by the prospect of his most recent book, Being Mortal, about medicine and end-of-life issues, including the story of Gawande’s father’s battle with cancer. Yet, I put off reading it for a bit because a book about death and dying isn’t exactly something you eagerly jump into. However, once I saw it on the best-seller shelf of my college’s library, I decided it was time and I’m glad I read it.
Though contemplating mortality is not high on my list of fun activities, I found Gawande’s exploration of how medicine may need to rethink end-of-life issues both thought provoking and sometimes even optimistic. Using stories of real patients and doctors (including himself), Gawande shows how the field of medicine, in its rush to “cure” or “treat” or “extend,” actually robs patients of quality of life and may actually speed up the dying process.
For example, nursing homes are set up to make care easier for nurses and doctors and to protect patients from dangers like falling or forgetting to take medications. However, to do so, they must take away many of the things that make life worth living for patients—privacy, choice, and connections to others. One of the most intriguing parts of the book for me was the discussion of the original idea behind assisted living—allowing inhabitants to have autonomy (the right to lock their doors) and community, but at the same time providing the assistance they needed in cooking, cleaning, etc. The original assisted living institution stuck to these principles but now the model has been diluted so much that this label gets used for any apartment living situation that is aimed at seniors (even ones that are just way stations for seniors before heading to nursing homes). At about the point that I was feeling so depressed about where I might end up as a senior, Gawande begins to tell story after story of how the situation is slowly starting to change and how new options for seniors are more seriously considering the importance of quality of life.
With this same dynamic in mind, Gawande tackles end-of-life issues for terminally ill patients and shows how the medical mindset—new treatment after new treatment to buy just a little more time—may not only shorten the time people have left but seriously impact the nature of that time. Gawande uses the story of his own father as well as several patients to discuss how much doctors can learn from the hospice model.
If you don’t want to think about dying or death, this may not be the book for you. However, Gawande made me see the importance of thinking about these issues both for myself and my loved ones and helped me to see the choices I may have in a situation where much is not in my control.