Being Mortal

I wish every doctor in the world would read Atul Gawande’s Being Mortal, because it speaks so eloquently—and practically, as well—to a fundamental change in the way we live. It’s a change we owe partly to modern medicine: we not only live longer but we die slowly. It used to be, Gawande says, that the majority of deaths came without much warning—heart attacks, sudden infections, strokes, or even the sudden onslaught of cancer for which medicine had no healing response. (TB was the one great exception.) Now our mortality tends to a long, slow decline.

Medicine tries to beat back this trend, fighting for life, but not paying much attention to what will make our lives worthwhile day by day. Because medicine is so dedicated to resisting death, it does a terrible job acknowledging its inevitability; and because it focuses more on disease than on the human beings who are diseased, it is quite capable of making our lives worse. Caught up in the dramatic imperatives of the medical system, people get lost and end up with miserable existences.

Gawande, a Harvard surgeon who writes for The New Yorker, tells the stories of many patients, including his own father, who had to negotiate this journey without much help from their doctors and sometimes with the doctors’ actual interference. He also introduces us to medical professionals who have thought long and hard about these matters, and gives us hope that a long, slow, miserable death is far from inevitable. Something can be done to make it better.

Gawande is attracted to the holes in medicine—not to modern miracle stories of bizarre diseases and heroic science, but to medicine’s blind spots and failings. He has written extraordinarily well about why medicine costs so much, and about why there are so many medical errors (and what can be done about it). But in writing about mortality, he has landed on a subject with deeper, more fundamental implications.

“The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging and mortality as medical concerns. It’s been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs.”

This social experiment has many sides, but perhaps the most pernicious is the loss of autonomy by the aging. Gawande quotes a colleague: “’We want autonomy for ourselves and safety for those we love.’ That remains the main problem and paradox for the frail. ‘Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.’”

Gawande explores the institutions we have designed for the elderly and the chronically ill—nursing homes and assisted living facilities—and helps us see how, by eliminating autonomy in the name of safety and care, they often create an inhuman environment. He describes in detail how 911 and ICUs and heroic cancer-fighting tools may actually shorten life as well as make its end horrible and inhuman. But he does much more than identify the disease, he probes for a cure.

It is hard to imagine that Gawande is really a surgeon, given that he is so willing to admit his own failings as a doctor, his own ignorance of how to treat his desperately ill patients.

The result is a very moving book, one that often brought tears to my eyes. It also made me think long and hard about my own life and the lives of others, about the kinds of questions and responses I myself make to friends who are seriously ill or dying.

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5 Responses to “Being Mortal”

  1. Bill Reichert Says:

    Beautifully wise, Tim. Both the book and your comments.

  2. Linda Fong-Elbaggari Says:

    Hi Tim, I subscribe to your blog and have been in the health field for 25+ yrs promoting nutrition and food as an adjunct to medical care. Thank you for the post. I will read the book by gawande. The only benefit I see to living longer is the is still a possibility for redemption and a turning to Christ with each living breath a person takes .

    Sent from my iPhone

    >

  3. karenkalinski Says:

    Thanks for your review. I will read the book. Love to Popie also.

  4. Lesley Van Dordrecht Says:

    Tim, and readers, check out this book: God’s Hotel by Victoria Sweet, a physician in San Francisco who, while writing the book, was studying the work of Hildegard of Bingen, and did a PhD on this subject of “slow medicine” focused on Hildegard’s work. It’s an amazing look at a different approach to the ill and dying and what makes people sick and well. She was working in the Laguna almshouse in the City, which is now defunct, and it’s nice to hear that story as well.

  5. fred prudek Says:

    Tim, Gawande makes a convincing argument that we need to rethink our view of the elderly. And I hope we do so quickly. It won’t be long before I join their ranks.

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