Thursday, May 14, 2015

Being Mortal

Dr. Atul Gawande’s Being Mortal tackles many of the elder care issues my wife and I have been dealing with for close to a decade.  Each of us has been the primary caretaker of our elderly parents (only our fathers survive at this point) for that long now, and just when we think we have seen it all, something new catches us by surprise.  I only wish that we had come across a book like Being Mortal ten years ago rather than having to learn the hard way much of what the Gawande has to say in it about aging and death.

Life is all about the choices we make.  And the choices we make as we approach the end of our lives – or the choices we help loved ones make as they approach the end of their lives – are every bit as important as any we have ever made.  Faced with the choice between prolonging our lives for a few months at the cost of losing the quality of our remaining time or living more comfortably and autonomously for what time we otherwise have left, what do we do?  The right choice is never as obvious as one might hope it would be.  Gawande suggests that quality over a slightly extended length of time is the wiser choice, difficult as that choice may be to make when the time comes.

Dr. Atul Gawande
So why do we face such a dilemma in the first place?  Gawande blames much of the problem on the medical profession.  Most doctors, he says, are so reluctant ever to give up on a patient that, despite the additional agony involved in further treatment, they will try one hopeless procedure or drug after another until that patient finally dies.  They effectively destroy the remaining lives of their patients by failing to disclose the inevitable result to them: they are going to die soon and it cannot be avoided.  Gawande argues that, rather than something for the doctor to decide, this ultimate choice must be placed in the hands of the patient.  Medical problems that cannot be fixed even at great physical and mental cost to the patient must be managed rather than fixed.  And it is up to the doctor to recognize when that point has been reached so that he can help his patient make the right choice.

My personal experience and observation, as verified by Dr. Gawande in Being Mortal, tells me that dying in the U.S. has become a big business.  For the most part, our elderly no longer die at home; they more often die in some hospital or nursing home with a nurse or two around to record the event.  It is all very impersonal and routine these days.  But Gawande is not ready to give up on his profession.  The growing trend toward the use of home hospice services and the efforts of some medical schools to train their students more fully gives him hope.  His greatest fear is that so few medical students are choosing to specialize in geriatric medicine that the elderly will suffer unnecessarily for a long time to come.

Being Mortal is an excellent resource for anyone faced with life’s inevitable choices – the hardest choices any of us are ever likely to have to make.


  1. I've read something else positive about this book. I've already been through the situation of dealing with the end of life with my parents and was frequently so angry with both attitude and lack of choices.

  2. Jenclair, I wish we had found something like this ten years ago. The doctor has a way of putting the whole struggle into a context that makes perfect sense...even though he admits in the book that he and his father found it extremely difficult to make the right choices when their turn came to make those choices.