Last year, shortly before I traveled to Virginia for the funeral of a favorite aunt, my former chief shared with me Atul Gawande’s award-winning best-selling treatise “Being Mortal: Medicine and What Matters in the End.” The book would serve as the impetus for the Downey Physician Wellness advance care directive project and provided a template for conversations I would have with my own family members on end-of-life issues.
The juxtaposition of stories from Dr. Gawande’s professional practice as a general and endocrine surgeon at Brigham and Women’s Hospital, as well as the personal narratives about his father and other family members’ illnesses lend authority and authenticity to the work. Any preconceived opinion about the bedside manner and temperament of surgeons is quickly dispelled by the empathetic, compassionate accounts he shares.
“This is a book about the modern experience of mortality.” It is about how physicians shepherd our patients and those we love through unchartered waters, the end of life. The author focuses on the quality of life, rather than longevity, with a special emphasis on autonomy of the patient. The same can be said of younger patients stricken with chronic debilitating diseases.
Gawande takes us further as he explores what makes life worth living when we are old and have to depend on others. He reminds us of the importance of making your wishes known formally (advance care directive, etc.) and informally (having those very delicate conversations with those we love).
His accounts of elderly patients being warehoused in nursing homes and the history of the development of assisted living so poignantly reminded me of the experience of my husband’s 104 year-old great aunt when she was moved from the assisted living facility she called home for 10 years to a nursing home for her safety. I am still haunted by thoughts of her being placed in a nursing home, where she died within 2 months after having seen her thrive in the “unsafe” environment of her assisted living “home.” What did we save her from? Thanks to his pointing out the important distinction between assisted living, nursing homes and hospice and what makes for the “best of” in each of these categories, I have a better understanding of what to look for in environments for senior citizens.
Gawande’s storytelling style will keep you engaged and you will find yourself taking every opportunity to devour a few more pages (suddenly waiting in lines won’t be so annoying). By his descriptions, real-life characters become very familiar and you may even think you recognize a former patient, or one of your own family members. You know them so intimately that you mourn their passing.
This surgeon questions whether our education and training adequately prepare physicians to make truly informed recommendations about how our patients, our family members, or how we approach the end of life. He makes vivid the image of plugging our elderly into walls (imagine patient on ventilator, dialysis, central lines, etc.) as we escalate care when we know or should know that gains are at best minimal, short lived, and at worst, do more harm: “…We may not stave off the damage but we stave off the death…”
Dr. Gawande reminds us that we need not fear aging, instead, we need to reshape the experience. Given the shortage of geriatric specialists, it is a conversation with which we all must become familiar. If you care for the elderly, have elderly family members, or intend to get older yourself, “Being Mortal” is a must read.
Book review by
Sylvia Swilley, MD
Pediatric Cardiology and Physician Wellness Champion, Retired