Being Mortal: Medicine and What Matters in the End

By Atul Gawande

(Holt, $26, 304 pages)

Who is this author?

Atul Gawande, the son of two doctors and a surgeon himself, is also a bestselling and prize-winning author and a staff writer for The New Yorker. Gawande’s books, all bestsellers, are Complications, which was a finalist for the National Book Award; Better, selected by Amazon as one of the 10 best books of 2007; and The Checklist Manifesto. He lives in Newton, Mass., with his wife and three children, is a surgeon at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School and the Harvard School of Public Health. He has won many major awards for his writing: a Lewis Thomas Prize for Writing about Science, a MacArthur “genius grant” Fellowship and two National Magazine Awards. And if all this were not enough, he also works in the public health field as Executive Director of Ariadne Labs, a center that pursues health systems innovation, and her is chairman of Lifebox, a nonprofit organization that works to make surgery safer around the world.

What is this book about?

Gawande is one of a growing number of author/doctors who understands that for all the advances medicine has made in treating illness, the profession still has much to learn about the experience of dying. Too focused on achieving a “cure,” even when common sense and medical wisdom clearly shows that death is inevitably on the way, doctors find themselves causing suffering in the name of keeping a patient alive as long as possible, and this counterproductive mindset has, if you will, infected patients and their families. Gawande speaks out in this wise book about issues of dignity and the human spirit and reminds us that how we live and how we die are more important than how long we hang on as the cascade of bodily shut-downs overwhelms us. The real issue, he believes, is not the failure to cure a patient but the failure to comfort and provide a sensible and humane ending when medicine has done all – or perhaps more — than it reasonably can be asked to do.

Why you’ll like it:

If you have ever wished you had a doctor who did not have a “God complex,” who would speak with you frankly, show deep understanding of  the physical and emotional turmoil you or a loved one is suffering and offer sensible and sympathetic advice, look no further: Dr. Gawande will see you now. He writes in a clear and concise way, using plenty of anecdotes from his years of practice and offering ideas and solutions that go beyond conventional approaches to treating those who are dying. This is an eye-opening book, full of hard-won wisdom. Don’t let the subject matter put you off: read this very important book.

Here is what Gawande told a Barnes & Noble interviewer about writing:

“I don’t write out of inspiration. . . . I write because it’s my way of finding cool ideas, thinking through hard problems and things I don’t understand, and getting better at something. I was never born to write. I was taught to write. And I am still being taught to write.”

He said this about why he wrote Being Mortal:

“This experiment of making mortality a medical experience is just decades old. It is young. And the evidence is it is failing.

“. . . this is a book about the modern experience of mortality— about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong. As I pass a decade in surgical practice and become middleaged myself, I find that neither I nor my patients find our current state tolerable. But I have also found it unclear what the answers should be, or even whether any adequate ones are possible. I have the writer’s and scientist’s faith, however, that by pulling back the veil and peering in close, a person can make sense of what is most confusing or strange or disturbing.

“. . . Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers.”

What others are saying:

An Amazon Best Book of the Month review for October 2014 says: “True or false: Modern medicine is a miracle that has transformed all of our lives. If you said “true,” you’d be right, of course, but that’s a statement that demands an asterisk, a “but.” “We’ve been wrong about what our job is in medicine,” writes Atul Gawande . . .  “We think. . .[it] is to ensure health and survival. But really. . .it is to enable well-being. And well-being is about the reasons one wishes to be alive.” Through interviews with doctors, stories from and about health care providers (such as the woman who pioneered the notion of “assisted living” for the elderly)—and eventually, by way of the story of his own father’s dying, Gawande examines the cracks in the system of health care to the aged (i.e. 97 percent of medical students take no course in geriatrics) and to the seriously ill who might have different needs and expectations than the ones family members predict. . . . Doctors don’t listen, Gawande suggests—or, more accurately, they don’t know what to listen for. (Gawande includes examples of his own failings in this area.) Besides, they’ve been trained to want to find cures, attack problems—to win. But victory doesn’t look the same to everyone, he asserts. Yes, “death is the enemy,” he writes. “But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee… someone who knows how to fight for territory that can be won and how to surrender it when it can’t.” In his compassionate, learned way, Gawande shows all of us—doctors included—how mortality must be faced, with both heart and mind.”

Kirkus Reviews says: A prominent surgeon and journalist takes a clear-eyed look at aging and death in 21st-century America. Modern medicine can perform miracles, but it is also only concerned with preserving life rather than dealing with end-of-life issues. Drawing on his experiences observing and helping terminally ill patients, Gawande offers a timely account of how modern Americans cope with decline and mortality. He points out that dying in America is a lonely, complex business. Before 1945, people could count on spending their last days at home. Now, most die in institutional settings, usually after trying every medical procedure possible to head off the inevitable. Quality of life is often sacrificed, in part because doctors lack the ability to help patients negotiate a bewildering array of medical and nonmedical options. . . .Yet the current system shows signs of reform. Rather than simply inform patients about their options or tell them what to do, some doctors, including the author, are choosing to offer the guidance that helps patients make their own decisions regarding treatment options and outcomes. . . . As Gawande reminds readers, “endings matter.” A sensitive, intelligent and heartfelt examination of the processes of aging and dying.”

In The New York Times Book Review, Sheri Fink writes: “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.” If that sounds vague, Gawande has plenty of engaging and nuanced stories to leave the reader with a good sense of what he means…Being Mortal is a valuable contribution to the growing literature on aging, death and dying. It contains unsparing descriptions of bodily aging and the way it often takes us by surprise. Gawande is a gifted storyteller, and there are some stirring, even tear-inducing passages here. The writing can be evocative…The stories give a dignified voice to older people in the process of losing their independence. We see the world from their perspective, not just those of their physicians and worried family members.”

“Beautifully crafted . . . Being Mortal is a clear-eyed, informative exploration of what growing old means in the 21st century . . . This should be mandatory reading for every American. . . . it provides a useful roadmap of what we can and should be doing to make the last years of life meaningful,” says

When is it available?

You can make an appointment with Being Mortal at the Downtown Hartford Public Library.

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