Being Mortal: Medicine and What Matters in the

End by Atul Gawande

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Original Title: Being Mortal

ISBN:
ISBN13:
Autor: Atul Gawande
Rating: 4.8 of 5 stars (994) counts
Original Format: Kindle Edition, 304 pages
Download Format: PDF, DJVU, iBook, MP3.
Published: October 7th 2014 / by Metropolitan Books
Language: English
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Health >Medicine- 479 users
Science- 465 users
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Description:

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 professions 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.

About Author:

Atul Gawande is author of three bestselling books: Complications, a finalist for the National Book
Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist
Manifesto. His latest book is Being Mortal: Medicine and What Matters in the End.
He is also a surgeon at Brigham and Womens Hospital in Boston, a staff writer for The New
Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He
has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two
National Magazine Awards. In his work in public health, he is Executive Director of Ariadne Labs,
a joint center for health systems innovation, and chairman of Lifebox, a nonprofit organization
making surgery safer globally. He and his wife have three children and live in Newton,
Massachusetts.
Other Editions:

- Being Mortal: Medicine and What Matters in the End (Hardcover)

- Being Mortal: Illness, Medicine and What Matters in the End (Wellcome)

- Being Mortal: Medicine and What Matters in the End (Paperback)

- Being Mortal: Medicine and What Matters in the End (Hardcover)

- Being Mortal: Medicine and What Matters in the End (Audio CD)

Books By Author:

- Complications: A Surgeon's Notes on an Imperfect Science

 - The Checklist Manifesto: How to Get Things Right

- Better: A Surgeon's Notes on Performance

- The Best American Science Writing 2006

- Gurir. Faillir

Books In The Series:

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- When the Air Hits Your Brain: Tales of Neurosurgery

- God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine

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Rewiews:

May 03, 2015

Will Byrnes
Rated it: it was amazing
Shelves: non-fiction, public-health, books-of-the-year-2014
(Added a link - 4/18/15 - at bottom) In the past few decades, medical science has rendered
obsolete centuries of experience, tradition, and language about our mortality and created a
new difficulty for mankind: how to die. Being Mortal is completely irrelevant for any readers
who do not have elderly relations, do not know anyone who is old or in failing health, and do not
themselves expect to become old. Otherwise, this is must-read stuff. Life may be a journey, but all
our roads, however long
(Added a link - 4/18/15 - at bottom)
In the past few decades, medical science has rendered obsolete centuries of experience,
tradition, and language about our mortality and created a new difficulty for mankind: how
to die.
Being Mortal is completely irrelevant for any readers who do not have elderly relations, do not
know anyone who is old or in failing health, and do not themselves expect to become old.
Otherwise, this is must-read stuff. Life may be a journey, but all our roads, however long or short,
whether express, local or HOV, whether traversed by foot, burro, bus, SUV, monster truck or Star
Trek transporter, converge on the same destination, and the quality of those last few miles is
something we should all be concerned about.
Old age is not a battle. Old age is a massacre.
Atul Gawande, as a doctor, has had considerable exposure to issues of death and dying, but when
his father was diagnosed with brain cancer, Gawande was motivated to look into how end of life
care was being handled across the board. Being Mortal is the distillation of what he learned.

Atul Gawande - photo by Aubrey Calo From Gawandes site

What we have today is the medicalization of old age. It has not always been thus. Instead of
embracing the circle of life, we have bent and twisted it until it looks like a Mbius strip. Facing the
fact that we are all going to die is certainly not a fun notion, but neither is believing we can extend
our so-called lives indefinitely. There really is such a thing as quality of life, and probably should
be a thing called quality of death as well.
hope is not a plan, and in fact we find from our trials that we are literally inflicting
therapies on people that shorten their lives and increase their suffering, out of an inability
to come to good decisions. - Gawande - from the Frontline segmentPeople have priorities
besides just living longer.

The percentage of the population that is elderly is rising dramatically as boomers enter their (our)
golden years. So how is the medical profession preparing to meet the booming demand for
geriatric care? With the same gusto as a Republican legislature faced with a crumbling
infrastructure. They are cutting back. I picture a cinematic bandit with a white coat under his
bandolier, "We doan need no steenking geriatricians." The reality is not far from this.
Although the elderly population is growing rapidly, the number of certified geriatricians the
medical profession has put in practice has actually fallen in the United States by 25 percent
between 1996 and 2010...Partly, this has to do with money--incomes in geriatrics and adult
primary care are among the lowest in medicine. And partly, whether we admit it or not, a lot
of doctors dont like taking care of the elderly.
Gawande tracks the history of late-life care from the poorhouse to the hospital to the nursing home
to the range of options currently available, providing information of the benefits and shortfalls of
each. Assisted care comes in for a lot of attention.
policy planners assumed that establishing a pension system would end poorhouses, but
the problem did not go away. In America, in the years following the passage of the Social
Security Act of 1935, the number of elderly in poorhouses refused to drop. States moved to
close them but found they could not. The reason old people wound up in poorhouses, it
turned out, was not just that they didnt have money to pay for a home. They were there
because theyd become too frail, sick, feeble, senile, or broken down to take care of
themselves anymore, and they had nowhere else to turn for help. Pensions provided a way
of allowing the elderly to manage independently as long as possible in their retirement
years. But pensions hadnt provided a plan for that final, infirm stage of mortal life.
There comes a point at which one passes from being elderly to being frail and the range of options
narrows. Gawande asks, What does it mean to be good at taking care of people whose problems
we cannot fix? When does the need for safety leap past a persons need for independence?
There are various levels of care offered at different sorts of facilities. Some people can remain at
home for a long time if they have a bit of help. Nursing homes are heavily medical, assisted care
facilities more independence oriented. And there are plenty of variations on each. Gawande looks
at several variations on assisted living facilities, noting the strengths and weaknesses. I found this
extremely interesting. He also looks at some techniques that can make assisted living more
tolerable, adding flora and fauna for residents to take care of for example, things like different sorts
of physical layouts. One of these reminded me very much of my daughters college dorm setup.
Point being that there is a spectrum and beginning from understanding the patient/resident needs
and desires in the context of physical and medical limitations can inform the choices to be made.
All too often these decisions are made without considering the impact on or getting input from the
person most affected.

Being Mortal looks at trends in the impact of using all available means to keep people alive, and
how that affects someones final days. When is the right time to stop treatment? How much is too
much? When is the right time to die? It used to be that, when it was time, ones final days were
spent at home, with family. These days, they are likelier to be spent in an institution of some sort,
and as likely as not, entail the patient being hooked up to sundry tubes, wires and flashing,
beeping devices. It is important to identify exactly what it is that a person wants, or fears most, as
a basis for decision-making. If your needs are minimal it speaks to one set of decisions. If your
needs are more substantial, it speaks to another. One person said that as long as he could watch
football and eat chocolate ice cream, life would be worth living. (There is no way he is a Jets fan)
Others have a more extensive list of must-haves in order to make life worth living. It does lead one
to consider what your list might include. For me, watching baseball would definitely figure in. Being
able to read and write, to communicate would be necessary. What if you couldn't clean yourself?
What if you could only have food through tubes? How much pain could you live with, and what
measures would be acceptable to ameliorate it? What would keeping me alive cost? And how
much is too much? All these questions figure into deciding the appropriate level of care. One
fascinating section here had to do with hospice care, which need not take place in a hospice
building. That was news to me. And it is a revelation how such care impacts patients.

One of the significant points of the book is that planning is paramount. Have those difficult
conversations. Talk about what you want for yourself, if your care is at issue, or what your
parent/friend/spouse/relation wants well before one is in a crisis situation. It may be
uncomfortable, but it is hugely important. In fact, this book is hugely important.

Being Mortal offers not just a fascinating look at the history of late life care and living options, it not
only offers a review of what is happening out there in the field of facilities for the frail and in the
theories of how to approach late life care, it not only offers sage advice on planning for
eventualities that we must all face sooner or later, it does all these things with humor and clarity,
the bookish equivalent of an excellent bed-side manner. It is a fast read, too, useful if time is short.
I would strongly suggest adding Gawandes book to your bucket list, beforeyou know it gets
kicked. This is must-read stuff.

Published 10/7/2014

Review Posted 2/13/15

=============================EXTRA STUFF

Links to the authors personal, Twitter and FB pages

The book was the basis for aFrontline episode, which is excellent

Here are thearticles Gawande wroteas a New Yorker staff writer

An interview with Gawande fromModern Health Care

Interview inMother Jonesmagazine

4/18/15 - GR friend Vaidya sent along a link to a wonderful January 2015 NY Times opinion piece
by Tim Kreider, You Are Going to Die, on facing what lies ahead. Worth a look. Thanks, V.

5/3/15 - An interesting Op-Ed on futility care

164 likes
97 comments

Lilo
P.S. As I said, I am not an atheist. I assume that there is a higher entity that is responsible for
creating the universe. And I have reason to believ
P.S. As I said, I am not an atheist. I assume that there is a higher entity that is responsible for
creating the universe. And I have reason to believe that there is an afterlife (due to a personal
experience with my grandmother appearing to me, some 22 years after her death).--However,
even if it turned out there weren't an afterlife, keep in mind that in such case, you would just cease
to exist and would not even have time to be disappointed.
What I am afraid of is not being dead. What I am afraid of is suffering before reaching this state.
And as German playwright/actor Curt Goetz had the main character say in his play (and movie)
"Frauenarzt Dr. Pretorius (Gynecologist Dr. Pretorius)", when he was comforting a patient who
was afraid of dying: "Bevor ich geboren wurde war ich Millionen Jahre tot, und es hat mir
gesundheitlich in keiner Weise geschadet. (Before I was born, I was dead for millions of years,
and it has harmed my health in no way at all.)" :-)

Oct 02, 2016 09:06PM

Brit Cheung
so compelling the review,mentor.

Dec 06, 2016 07:33AM