Review: Being Mortal: Medicine and What Matters in the End

Being Mortal: Medicine and What Matters in the End by Atul Gawande
My rating: 5 of 5 stars

Few of us have truly confronted our mortality. For my friends and I that are reaching middle age the stretch of days, months, and years we expect to have in our future seems almost limitless. I'll be turning 40 this year, and that probably isn't even the midway point of my life if I happen to be blessed with the same longevity of much of my family. Those days are finite, however, and we all need to regularly review what measures we would take to extend our life and what we would consider a life worth living. What's more, many in my shoes will be taking care of their own parents, if not now then soon. We need to be able to discuss what makes for a meaningful life and our wishes. This book provides an excellent window into how modern medicine often substitutes quantity of life for quality of life, and how to approach the hard decisions we must face as we approach our end.

If you read nothing else, stop in a library or bookstore and browse the epilogue. There you will find the condensed version of the book. Doctors want to fix, heal, and provide hope. We all die, however, and there is no beating death. Given that, at what point should extreme measures be taken that provide little hope of improvement. In many cases a patient will choose to undergo painful, debilitating chemotherapy in the hope of one day fully springing back to their youthful selves. The reality is that the procedure will most likely not work, and even if it does, will leave the patient at a plateau within their disease.

In addition to the discussion of medical choices, there are also fantastic chapters on attitudes towards the elderly. As we grow old, we lose our independence. That can be frustrating and frightening. Hospitals and traditional nursing homes further remove that independence by demanding that patients live on the schedule most effective for the staff, not what is most comfortable for the patient. Patients begin to feel that they are simply being stored off until death takes them rather than continuing to live fruitful and worthwhile lives. Contrast this to the independent and assisted living centers which allow such simple but meaningful forms of autonomy as choosing the thermostat settings for your room, choosing when to eat, and when to bathe. What seem like trivial freedoms are huge for those who have already suffered diminished autonomy.

Being Mortal is an important book, and an important subject for everyone to confront and have frank conversations about. This book is a great way to start that process.

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