A Book Review —
Being Mortal: Medicine and What Matters in the End by Atul Gawande
Picking a doctor’s brain, but hearing his heart – that’s how I would describe the experience of reading Dr. Gawande’s reflection upon how he has learned to practice medicine. The book stirs up uncertainties and memories; it is an easy read, but in the simplicity of the stories he tells, and the research he cites, Dr, Gawande urges us to slow down and think about the medical choices we make – and talk about what we want, and why, remembering that
They come to rest at any kerb;
All streets in time are visited. – Philip Larkin, Ambulances
In western cultures, we have come to expect deliverance from the health problems that killed our grandparents – or great grandparents – but not from the reality that our bodies wear out and we die. Some of us may not make it to the golden years – many are cut off by diseases that rob us of our freedom to “shape our lives in ways consistent with our character and loyalties.” The challenge Dr. Gawande poses that all of us must answer, not just the professionals, is: “[H]ow we can build a health care system that will actually help people achieve what’s important to them at the end of their lives.”(Page 155)
Ideally the system should be about balancing what modern medicine can do to buy time, and understanding what that miracle costs in terms of additional pain and suffering. Being Mortal opens a hard conversation on how to make life worth living even when we’re weak and frail and can’t fend for ourselves anymore.
Doctors are [often] no better prepared to face the brick wall death is than their patients are. Because [t]echology can sustain our organs until we are well past the point of awareness and coherence, we need to have some hard conversations. He was taught better ways of engaging with patients than just dropping information on them – and expecting them to make a smart decision. He admits he has been a slow learner as he recounts interviews with other professionals, and his patients. And he is candid about how slowly he put into practice what he learned – but his experiences edify and encourage readers, as well as caution us. Sometimes, we are just up against the unfixable. (Page 223)
In the second half of Being Mortal, Dr. Gawande describes how asking instead of telling patients enables doctors and nurses to help families to live until they die.
A better way is slow down the conversation about treatment “options” and expression compassion; ask the patient, what is important – given that time may be shorter than they hoped. Don’t shut out other family members from these conversations.
He reinforces his lessons with experiences of courageous people – people who had substantive discussions with their doctors and families about their end-of-life preferences, and spared their family anguish (Page 177)
- If time becomes short, what is most important to you?
- What are your fears?
Not exactly questions we want to spend time pondering – but, during his father’s battle with cancer, what Dr. Gawande and his family all came to witness was the fruit of thinking through these matters, and discovering “the consequences of living for the best possible day today instead of sacrificing time now for time later.” (Page 229)