Monday, November 11, 2019

Being Mortal: Medicine and What Matters in the End by Atul Gawande

Reviewed by Jeanne

Modern medicine has had an enormous impact on society, and not just in the form of longer lifespans.  There seems to be a general feeling that medicine can fix any problem with a pill or an operation or a procedure. Dr. Gawande is concerned about the unrealistic expectations people have when faced with illness or with aging, and it’s not just the patients:  doctors have fallen into the habit of being “Dr. Informative,” which means just supplying facts and information without going into the ramifications of some decisions, failing to explain choices and consequences adequately. There’s also the idea that each specialist is focused on one aspect of a patient’s condition and doesn’t consider the effects on other problems.

Using real life cases, Gawande describes several different decisions and outcomes. He emphasizes that there is no one right answer that fits every case.  Instead, he thinks every patient needs to answer three questions:  What are your fears and what are your hopes? What are your goals? What trade-offs are you willing to make and what would you not? The answers can be a guide to how to proceed.

He also discusses aging and the possible solutions: staying with family, independent living, assisted living, and nursing homes, including how the philosophy behind eldercare has changed.  He also asks the reader to think about what he or she considers essential to a good quality of life, noting that our priorities change in response to circumstances.  He also wonders if opting for safety over independence in old age is detrimental in some cases, lowering the quality of life.

In a nutshell, the book comes down to goals, no matter one’s age.  It’s not necessarily large goals, like climbing Mt. Everest or becoming a millionaire; it can be something like taking an art class or visiting a museum you always meant to go see to but never have. 

Book Bingo inspired me to finally read this book which had been in my To Be Read pile for quite some time.  So many reviewers had called this a “must read” that I was a bit intimidated, and frankly, it’s not an easy topic. However, the reviewers were right: it is a “must read” and not just for those of a certain age.  I liked the way that the author handled the subject, illustrating various points by letting us learn about (and become fond of) real people faced with such choices.  He is a sympathetic ear, and he doesn’t pretend he has all the answers—this is especially apparent in the cases that touch on his own relatives—but he displays compassion and concern.

Some years back, I had read a book with a similar theme, Making Rounds With Oscar by David Dosa.  Using the viral story of a nursing home cat who is purported to know when someone is about to die, Dosa asks readers to consider what they want for their loved ones or for themselves when age and infirmity lead to serious decisions.  Oh, yes, and he mentions the cat at times—always a plus for me.

Both authors emphasize the need for families to sit down and talk some of these issues out before an emergency arises.  Under the stress of a diagnosis or accident, people tend to immediately default to “do everything possible!” instead of “do what it takes to let me live the best way I can.”

For me, Being Mortal was not just about end of life issues, but about making use of the time we have.  I’ve had a list of local places I mean to visit someday, but there never seemed to be a good time.  This book has me thinking that perhaps I should go ahead and make time now, because we never know what is waiting around the corner.