Being Mortal: Medicine and What Matters in the End, by Atul Gawande
Metropolitan Books / 2014 / 282 pages
Audiobook narrated by Robert Petkoff
Macmillan Audio / 2014 / 9 hrs and 3 mins
Lately, there seems to be a spike in the number of popular books — particularly memoirs — written by physicians and focusing on the issue of medicine. Maybe this has something to do with aging baby boomers or our society’s preoccupation with health and wellness — or perhaps it’s the opposite and we’re overly obsessed with death. Whatever the reason, I can’t be the only one who has noticed this literary trend.
Because I read When Breath Becomes Air by the late Paul Kalanithi (and loved it, as per my review here), I was a bit hesitant to read Atul Gawande’s Being Mortal. I thought they would be too similar. In some ways they are, but where Kalanithi’s story is on facing death in the prime of one’s life, Gawande’s centers on the aging process and what society and the medical profession needs to do to honor life with a more compassionate approach to death, rather than prolong the inevitable at any cost. For all of medicine’s advances, we still haven’t gotten this right.
“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”
Those conversations, Gawande writes, are where doctors and loved ones need to place their emphasis. We need to do more talking about what is important to patients and what their understanding is regarding the nature and prognosis of serious, terminal illnesses. In Being Mortal, Gawande shares those personal conversations — the ones he’s had with his family, loved ones, and patients — and how they’ve shaped his perspective as a doctor and a human being.
“Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be. We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?”
Gawande views life as a story with each of us holding the pen. “You may not control life’s circumstances, but getting to be the author of your life means getting to control what you do with them.” It’s an effective analogy.
“All we ask is to be allowed to remain the writers of our own story. That story is ever changing. Over the course of our lives, we may encounter unimaginable difficulties. Our concerns and desires may shift. But whatever happens, we want to retain the freedom to shape our lives in ways consistent with our character and loyalties. This is why the betrayals of body and mind that threaten to erase our character and memory remain among our most awful tortures. The battle of being mortal is the battle to maintain the integrity of one’s life—to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be.”
I listened to Being Mortal on audio and found it to be incredibly engaging. Gawande has a very practical yet compassionate narrative style that (at least in my experience) is rare among physicians. If his bedside manner is anything like his prose, his patients are in good hands.