Book Review: Being Mortal
Reviewed by Kris Palmer & Allen Borton, CTH Website Contributors
In “Being Mortal,” Dr. Atul Gawande, a busy, active surgeon, captures beautifully what is meant (and not meant) by the phrase “a good death,” as he explores the difficulties inherent in his profession of medicine in the challenging period described as “end of life and the need to transform that experience.” He offers a pertinent account of how Americans deal with mortality and individual decline, noting that dying in America is both lonely and complex. Prior to World War II, people generally spent their final days at home, but now most finish life in institutions, often following the trial of every possible medical intervention in an attempt to ward off what is truly inevitable. The author provides an intelligent and sensitive survey of this difficult issue, reminding readers that “endings matter.”
Dr. Gawande discusses the unintended suffering that has been produced, describing it with fascinating anecdotes regarding his own family and his patients. Nursing homes and residents battle over such issues as the choices they can make and the food they can eat – torn between the institution’s desire for safety and the wish to maximize residents’ freedom.
Gawande’s personal journey with hospice care started when he accompanied a hospice nurse on patient rounds. He learned that hospice was not about “morphine drips” but was about honoring what makes living important to each patient. His hospice journey continued when his father received home hospice, where he learned about a “different kind of care” which he defined as care that focuses on making today the “best possible day.”
What is really important according to Gawande, is to have “the hard conversation” with patients suffering from serious illness. Doctors need to learn to ask patients about their specific fears, goals, and the trade-offs they are willing to make, allowing each patient to define for him/herself the meaning of quality of life. Only then are physicians equipped to outline treatment alternatives for patients in terms that are personally meaningful to them. And, that’s what makes a different kind of medicine possible.