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.

Nevermore: The Irish Game, Being Mortal, Shattered Genius, Good Advice, and Assorted Cats

There are only two privately held paintings by Vermeer in the world.  The Queen of England owns one.  The other is held by a family in Ireland.  In The Irish Game, Matthew Hart tells the true story of how the Irish painting was stolen, recovered, and then stolen again.  The book won rave reviews from our Nevermore reader who found it a fascinating tale and one well told.  The author brings together a number of subjects which had a bearing on the case: security systems, art history, Irish politics, international crime, art restoration, gangs, and even illegal drugs. The book comes highly recommended.

Also highly recommended was Being Mortal:  Medicine and What Matters in the End by Atul Gawande.  Gawande believes that modern medicine and culture focus more on sustaining life at the end than in making the last years or months comfortable and pleasant.  He explores what makes life enjoyable for an elderly person and how nursing homes, hospice, assisted living, and family caregivers fail or succeed. He asserts the need for quality of life and for the elderly to still be allowed to make their own decisions.  Our reviewer found it both thought-provoking and enlightening, and Amazon.com readers agree: 87% of readers gave it five stars and another 11 % gave it four.

On a similar theme, an older book by Dr. David Dosa also asks some of these same questions.  Making Rounds with Oscar is ostensibly about Oscar, a nursing home cat who seemed to know when someone was in his last hours.  Dr. Dosa wrote a paper about Oscar which drew international attention, encouraging him to look further.  He does, but much of the book examines how the elderly are treated by both institutional personnel and by families.  I found it to be a thoughtful book, one which made me not only think about how elderly relatives had been treated but also how I would like to be treated myself one day.  It’s a low-key, non-threatening book, which makes it ideal to start a conversation.

Shattered Genius by David Storm examines the German General Staff which began when the area was still Prussia.  It was a group of officers who were selected on merit and who studied all aspects of warfare, and which proved extremely effective throughout the nineteenth century.  World War I was their first great defeat and, in accordance with the Treaty of Versailles, they were disbanded.  However, there was a core group who remained active in a different guise and was ready to be utilized.  Much of the book is devoted to the World War II General Staff and their relationship with Hitler.  Our reviewer enjoyed the book and proposed a longer review later.

In a lighter vein, Zac Bissonnette has been good enough to compile a collection of Good Advice from Bad People:  Selected Wisdom from Murderers, Stock Swindlers, and Lance Armstrong.  Bissonnette has a brief quotation from a person, and then follows it with a short biography of the person which demonstrates that he or she does the opposite. Our reviewer thought it was a lot of fun, and a good, quick read.

She also recommended Careers for Your Cat by Ann Dziemianowics which details how you can determine what profession would best suit your cat.  She even provides a Meowers-Briggs Personality test to help you determine if your cat is living up to his or her potential. Our reviewer said that while she only laughed out loud a couple of times, it did make her smile a lot, and she recommends it as a fun book.  Note:  both the books listed above were downloaded from the library’s READs program!