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Medicine and What Matters in the End
by Atul Gawande
Book Reviewed by: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 profession's 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.
Introduction
I learned about a lot of things in medical school, but mortality wasn't one of them. Although I was given a dry, leathery corpse to dissect in my first term, that was solely a way to learn about human anatomy. Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives, and how it affects those around them seemed beside the point. The way we saw it, and the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise. The one time I remember discussing mortality was during an hour we spent on The Death of Ivan Ilyich, Tolstoy's classic novella. It was in a weekly seminar called Patient-Doctor—part of the school's effort to make us more rounded and humane physicians. Some weeks we would practice our physical examination etiquette; other weeks we'd learn about the effects of socioeconomics and race on health. And one afternoon we ...
Which book(s) have you read at least three times as an adult?
I have no idea how many times I've read Pride & Prejudice and A Christmas Carol. Suffice it to say, "many." I guess the re-reads are almost entirely classics - A Tale of Two Cities, Bleak House, and Jane Eyre are novels that stand out in my memory as those I've re-read multiple times. In fact, I ...
-kim.kovacs
Here are some of the comments posted about Being Mortal in our legacy forum.
You can see the full discussion here.
"It is not death that the very old tell me they fear. It is what happens short of death," In what ways do you relate to that fear or not? What do you fear most about what happens short of death?
I'm 80 years old, and death does not scare me. I've live a full life with both joys and sorrows, and at 80 years of age, no one depends on me, so I feel that I've "served my purpose" and any good time from here on out is dessert! Obviously I don't ... - Jan Mays
As Dr. Gawande learns the limitations of being Dr. Informative, how did your perception of doctors and what you want from them change? What would you want from your doctor if you faced a serious illness?
I don't think what I want from a doctor changed at all. I have always been one to seek out doctors that treat me like a person and not a disease. Even with my high blood pressure, we discuss things and then I choose what medications I'm willing to ... - scottishrose
As you consider the life you want lead in old age, what does home mean to you?
Home is a place that is familiar -- a place which brings me comfort. I will very likely have to move in the not too far off future. And, very likely will be doing it alone (Husband not well and much older). It will be hard - leaving my present ... - karenj
Based on your reading of this book, what piecs of advice would you give to someone younger than you, a peer, and someone older?
Yes, I agree with above. Shop around for the right doctor, and be assertive about your care. For younger people, realize that aging is part of life and not something to avoid looking at. My husband didn't want our "kids" (oldest is 37) to see his 91-... - juliep
Did you read Alice Hobson's story as an inspiring one, or as a cautionary tale?
It is a cautionary tale. I think it is hard to force the medical profession to acknowledge that death is a fact of life and in many situations the bestfor everyone. Too often the discussion appears to be an issue of money versus life, but mere life... - paulagb
Indie Booksellers’ Choice Awards
2015
Many people are not comfortable contemplating their own aging and mortality. Nevertheless, I finished Being Mortal feeling like this is an important book and one that I would be eager to discuss with others. I highly recommend it; although it's nonfiction, it's extremely engaging and should hold the attention of fiction lovers as well as those who prefer books in the social sciences. Most will undoubtedly come away with a new perspective on these important issues...continued
Full Review
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(Reviewed by Kim Kovacs).
Malcolm Gladwell
American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande's most powerful--and moving--book. Oliver Sacks
Being Mortal is not only wise and deeply moving, it is an essential and insightful book for our times, as one would expect from Atul Gawande, one of our finest physician writers.Hospice is a medical specialty that focuses on end-of-life care for individuals and support for their families. Its roots come from the Latin for hostis meaning stranger, and more specifically from hospitem meaning a guesthouse - from these roots we also get hospital, hotel and hospitality.
The idea of caring for those suffering from fatal diseases has been around for centuries. In the Middle Ages, religious orders established shelters along pilgrimage routes designed to aid those journeying to and from sacred sites, many of whom were terminally ill, and are considered the original form of hospice care. The idea was expanded in the 16th through 18th centuries, when monasteries began opening facilities for those who were impoverished and...
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Give me the luxuries of life and I will willingly do without the necessities.
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