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The BookBrowse Review

Published September 20, 2017

ISSN: 1930-0018

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Book Jacket

Being Mortal
Medicine and What Matters in the End
by Atul Gawande
5 Sep 2017
304 pages
Publisher: Picador
ISBN-13: 9781250076229
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In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending.

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

Published in hardcover and ebook in 2014. Reprinted in paperback in 2017.

Some of the recent comments posted about Being Mortal. Join the discussion! You can see the full discussion here.

Please be aware that this discussion will contain spoilers!

"It is not death that the very old tell me they fear. It is what happens short of death," In what ways do you relate to that fear or not? What do you fear most about what happens short of death? (16 responses)

I'm 80 years old, and death does not scare me. I've live a full life with both joys and sorrows, and at 80 years of age, no one depends on me, so I feel that I've "served my purpose" and any good time from here on out is dessert! Obviously I don't want to experience pain and ultimately ... - Jan Mays

As Dr. Gawande learns the limitations of being Dr. Informative, how did your perception of doctors and what you want from them change? What would you want from your doctor if you faced a serious illness? (11 responses)

I don't think what I want from a doctor changed at all. I have always been one to seek out doctors that treat me like a person and not a disease. Even with my high blood pressure, we discuss things and then I choose what medications I'm willing to take or what life changes I'm willing to make - scottishrose

As you consider the life you want lead in old age, what does home mean to you? (21 responses)

Home is a place that is familiar -- a place which brings me comfort. I will very likely have to move in the not too far off future. And, very likely will be doing it alone (Husband not well and much older). It will be hard - leaving my present home and all my friends. Yet it will be necessary as... - karenj

Based on your reading of this book, what piecs of advice would you give to someone younger than you, a peer, and someone older? (3 responses)

Yes, I agree with above. Shop around for the right doctor, and be assertive about your care. For younger people, realize that aging is part of life and not something to avoid looking at. My husband didn't want our "kids" (oldest is 37) to see his 91-year-old mother as she declined, and I ... - juliep

Did you read Alice Hobson's story as an inspiring one, or as a cautionary tale? (6 responses)

It is a cautionary tale. I think it is hard to force the medical profession to acknowledge that death is a fact of life and in many situations the bestfor everyone. Too often the discussion appears to be an issue of money versus life, but mere life is not worth living without some quality. My ... - paulagb

Do you agree that the 80-year-old man who refused to move from his home as Mt. St. Helen's began to erupt had a right to decide his fate. What are the implications for individuals and families when elder adults are given full autonomy over their lives? (3 responses)

Yes, I believe he had the right to decide to stay at home rather than evacuate. I think it's just like deciding you would rather die at home than in a hospital. I think families and caregivers should honor such requests even though it may not be the accepted thing to do - darylb

Doctors, and probably the rest of us, tend to define themselves by their successes, not their failures. Is this true in your life? Should we define ourselves more by our failures? How can doctors, and the rest of us, strike a balance? (8 responses)

Rather than defining ourselves by our failures, I think we need to try and learn from them. No one is successful at everything. Acknowledge where you went wrong and try to make sure you don't make the same mistakes again - darylb

Dr. Gawande suggests we aren't taking advantage of the opportunity to make the experience of aging better. In what ways could we improve aging in our daily lives and as a culture? (6 responses)

We can improve aging by focusing on healthy habits in food and exercise and by having a positive attitude. I do agree with all of the above and have seen the benefits (as a youngster and now as an oldster) of relationships with people of all ages. As a culture, I think we are headed in the right ... - janp

Have you ever lost someone you care about to serious illness? What is the best way to empathize and comfort those facing life-threatening illness? How prepared do you feel to do and say the right thing? (5 responses)

I have lost family members and friends, the most recent being a dear friend who died recently. It was the first time I was allowed to be a part of someone's life to the end. When she was diagnosed all I told her was that I wanted to be with her in any way possible, whatever role she needed or ... - janp

Have you ever seen anyone die or been with someone in the final stages of life? Can you describe that experience? How did the experience affect your wishes for the end of your own life? (18 responses)

I spent the better part of five days with my dad when he was in a coma and dying in the hospital. I have nothing but praise for the staff at that hospital as I felt they took better care of him and providing for his comfort in an unconscious state than other hospitals he had been in during the last ... - scottishrose

How do we strike a balance between our fear of dying and our hope for a long, healthy life, while still confronting reality? (12 responses)

Maybe the way is to educate and prepare ourselves while we're still healthy - marianned

How was your reading affected by the book's final scene, as Dr. Gawande fulfills his father's wishes? How do tradition and spirituality influence your concept of what it means to be mortal? (5 responses)

I was very touched that Dr Gawande fulfilled his fathers wishes even though he was not necessarily a believer in the legend. A beautiful ending to the book - darylb

If you had to make a choice for a loved one between ICU and hospice, what would you most want to know from them? What would you be willing to endure and what would you not be willing to endure for the possibility of more time? (12 responses)

I would choose hospice. My dad suffered a brain hemorrhage on the day he was supposed to return to assisted living from the hospital. Because he had been badgered into getting a pacemaker the summer before by hospital staff, it took him days for his body to shut down and die as his heart was beating... - scottishrose

In chapter 8, Dr. Gawande describes the choices made by his daughter's piano teacher, Peg Bachelder. If you were facing similar circumstances, what would your good day look like? (11 responses)

As with many of the above, my good day would revolve around family. Hopefully any pain would have been alleviated. I hope I would have come to terms with death and be at peace with it - juliep

What activities might you envision doing that would bring you fulfillment in your retirement when you might face some physical limitations? (13 responses)

If I were hampered with physical limitations, I would find a way to compensate. As an avid reader and Book club member, I would certainly substitute audio books and/or use if my eyesight declined. I would also still attend and participate in Book Club discussions. I could still listen to... - Sooz

What are your feelings about hospice care? When is the appropriate time to introduce hospice in the treatment of those with life-threatening illness? (16 responses)

Having seen the caring nature of the hospice team that took care of my husband in his final weeks, I am a great supporter of letting hospice take over the task of keeping a patient free of pain and administering patient, loving care to those in a terminal situation. I also agree that the family ... - Sooz

What are your thoughts about assisted suicide? (14 responses)

I think it gives a patient some power in a situation where one feels completely powerless. And that's a mighty thing. Whether it gets used or not, to be able to make that decision for oneself is a comfort...for everyone involved. I agree with others that it needs to be discussed early and often - josellek

What came to your mind when Bill Thomas outlined the Three Plagues of nursing home existence: boredom, loneliness, and helplessness? What do you think matters most when you envision eldercare? (15 responses)

I think that depends on what you make of it. For my grandpa who wasn't able to drive the last few years before going into a nursing home, he found that there were people there to talk to and play cards with it. I think it made his last few months less lonely. For my dad, on the other hand, he only ... - scottishrose

What can be learned from the medical treatment choices that were made in the final days of Sara Monopoli's life? (8 responses)

This was such a sad story - heartbreaking - a young woman and a new mother. I think if he doctor had been more direct with her and educated her more on hospice she may have gone on to hospice sooner. She suffered needlessly. As a family they needed more guidance and should have been educated and ... - charleneds

What did you discover about the physiology of aging? What is your attitude toward aging? (8 responses)

Having studied gerontology in my graduate work I always focused on the ordinary people I saw doing what I thought were extraordinary things. It turns out that they were often doing what they always did. It was just that they were still doing those things at 75, 80, even 90. Yet behind their ... - kbschaffer

What do you think Dr. Gawande means when he says that we've "medicalized" mortality? Do you agree? Why do you think that has happened? How can we shift to a more humane approach? (15 responses)

Rather than "medicalized" mortality, my parents each chose to reach out to Hospice for their final days. Our family fully participated and only hope that our own passing is as peaceful, painless and gentle - lilc

What does it mean to you to treat someone with serious illness as a person and not a patient? (12 responses)

It means asking them what they think and how they feel rather than telling them what you think they need to do. Unless a person has dementia and can no longer make decisions for themselves, any person who is ill should always have the right to make decisions affecting their life - scottishrose

What is your attitude toward old age? Do you think most people are in denial about their own aging? (7 responses)

Dr. Gawande says it all. In short, life is what you make it. Doctors must be educated to keep us in good health through our our lives and be aware of alternative life styles to match our emotional and physical needs.
Such a smart doctor - lilc

What realities are captured in the story of Lou Sanders? What conflicts did his daughter face between her intentions and the practical needs of the family and herself? What does the book illustrate about the universal nature of this struggle for families? (3 responses)

I agree with renem. Caregivers are not only struggling with role reversals, but with the sudden burden of making decisions that can break so many different pieces of their lives and the lives of their families. No one should have to manage everything in a vaccuum. She should not have had to deal ... - ylhoff

Why do you think it's so difficult for doctors and/or families to refuse or curtail treatment? How should priorities be set? (15 responses)

What I learned with my dad was that when he ended up in the ER because of a fall or pain, the doctors would treat his symptoms and send him back to the nursing home. It was like all they saw was an old man and they didn't even try to find out what was causing the problem. During his last ER visit ... - scottishrose

"Being Mortal, Atul Gawande's masterful exploration of aging, death, and the medical profession's mishandling of both, is his best and most personal book yet." - Boston Globe

"American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande's most powerful--and moving--book." - Malcolm Gladwell

"Beautifully crafted ...Being Mortal is a clear-eyed, informative exploration of what growing old means in the 21st century ...a book I cannot recommend highly enough. 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." -

"Masterful ...Essential ...For more than a decade, Atul Gawande has explored the fault lines of medicine ...combining his years of experience as a surgeon with his gift for fluid, seemingly effortless storytelling ...In Being Mortal, he turns his attention to his most important subject yet." - Chicago Tribune

"Beautifully written ...In his newest and best book, Gawande ...has provided us with a moving and clear-eyed look at aging and death in our society, and at the harms we do in turning it into a medical problem, rather than a human one." - The New York Review of Books

"Atul Gawande's wise and courageous book raises the questions that none of us wants to think about ...Remarkable. - John Carey, The Sunday Times - UK

"We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. However it is not only medicine that is needed in one's declining years but life--a life with meaning, a life as rich and full as possible under the circumstances. Being Mortal is not only wise and deeply moving, it is an essential and insightful book for our times, as one would expect from Atul Gawande, one of our finest physician writers." - Oliver Sacks

"Eloquent, moving." - The Economist - Best Books of 2014

Write your own review

Rated 5 of 5 of 5 by Peggy
Warning: Aging-Approach with Caution!
This book adds greatly to the conversation of aging, death, and quality of life issues. It goes further than most by flipping the discussion on its head by not defining a "good death" but rather the a "good life". One should always strive to define for themselves what they want to do-- not allowing the medical establishment to try to prolong life as long as it can. Autonomy, dignity, and personal choice can only be decided by the individual. Sometimes families lovingly get in the way of the dying.

My only criticism is that Dr Gawande's sharing of many anecdotal stories became somewhat redundant. His account of his fathers' death, however, was very moving! The book needed tighter editing in my opinion. Overall, I highly recommend. His list of source material is extensive and provides further investigation for those interested.

Rated 5 of 5 of 5 by Dot
What you should know as you age
Well written, author provides insight to the issues of people as they age and the things they need to consider as they age. A must for Boomers and their family.

Rated 5 of 5 of 5 by Gloria
Recommended reading
Atul Gawande's "Being Mortal" actually made me feel better about growing older and, eventually, frailer. Just knowing that there are people like him that are trying to make longer lives better lives gives me great comfort. This book should be in every home. And now I want to read his other books, too.

Rated 5 of 5 of 5 by Nancy
Palliative Care
This should be required reading for anyone over 30.....what Gwande has to say is important.....we are all mortal and at some point the effort to cure should be replaced with the effort to provide humane support and freedom from end our lives with dignity and peace....the medical profession and family members need to understand that treatments which prolong life at all costs ,no matter how well intended,only prolong pain and suffering.....professional hubris and selfish justification need to give way to a more humane acceptance of reality .....and certainly Hospice is one option for doing just that....clearly written with reason and compassion this book is a definitive argument for a realistic approach to illness and death.

Rated 5 of 5 of 5 by Cloggie Downunder
Being Mortal is the fourth book by American surgeon and author, Atul Gawande. Early on in his book, he tells us :“…the purpose of medical schooling was to teach how to save lives, not how to tend to their demise” and that “I knew theoretically that my patients could die, of course, but every actual instance seemed like a violation, as if the rules I thought we were playing by were broken. I don’t know what game I thought this was, but in it we always won”.

But don’t get the wrong idea: this is not a book about dying, so much, as a book that looks at how the latter hours, days, weeks, months or even years of life can be improved. As we get older, and usually frailer (because there is no “…automatic defrailer…” p44 available to us), we need to rethink where the emphasis should lie: “…our most cruel failure in how we treat the sick and the aged is the failure to recognise that they have priorities beyond merely being safe and living longer…”

“We end up with institutions that address any number of societal goals – from freeing up hospital beds to taking burdens off families’ hands to coping with poverty among the elderly – but never the goal that matters to the people who reside in them: how to make life worth living when we’re weak and frail and can’t fend for ourselves”. Gawande’s wife’s grandmother, when institutionalised, remarked: “She felt incarcerated, like she was in prison for being old”

Gawande backs up his ideas with plenty of data that is both fascinating and revealing. And while an information dump could be boring, he illustrates all this with the results of studies and anecdotes about real people. It doesn’t get much more personal than the experience of his own father’s decline.

“Our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come…”

While many practitioners of palliative care will be familiar with what Gawande says, this book should be compulsory reading for most health care professionals. Oncologists, gerontologists, surgeons and intensivists (and their patients!) in particular would benefit from reading this book from cover to cover; those of us with ageing or debilitated family members, or those wanting to plan for their own eventual decline, would also find this book interesting and useful.

He concludes: “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?” Recommended.

Atul Gawande, MD, MPH, is a surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women's Hospital. He is Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School. He is also Executive Director of Ariadne Labs, a joint center for health systems innovation, and Chairman of Lifebox, a nonprofit organization making surgery safer globally.

Atul has been a staff writer for The New Yorker magazine since 1998 and has written four New York Times bestsellers: Complications, Better, The Checklist Manifesto, and most recently, Being Mortal: Medicine and What Matters in the End. He is the winner of two National Magazine Awards, Academy Health's Impact Award for highest research impact on healthcare, a MacArthur Fellowship, and the Lewis Thomas Award for writing about science.

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