Being Mortal

 

Book review: ‘Being Mortal” by Atul Gawande

By MARY ELIADES

 

Aging and death are not exactly popular topics on the dinner party circuit, but a new book by bestselling author Atul Gawande makes the point in his latest book, “Being Mortal,” that end-of-life issues can be managed with dignity, autonomy, and even joy.

Gawande, a practicing surgeon and award-winning writer, is also a professor at Harvard Medical School and the Harvard School of Public Health. He has been a staff writer for The New Yorker since 1998 and most recently wrote an interesting piece entitled “Overkill” in the May 11 edition, on the waste and danger of unnecessary medical care.

In “Being Mortal,” Gawande draws on his personal experiences as a surgeon, as well as family history and research results, to delve into the age-old questions around aging and death.

The premise of his book is that doctors have always been committed to the bottom line of medicine – extending life. Medicine has triumphed over many of life’s traumas – injuries, diseases, birth – but with a matching decline in quality of life for many approaching death.

In the book’s introduction, Gawande writes, “The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions – nursing homes and intensive care units – where regimented, anonymous routines cut us off from all the things that matter to us in life.”

The most affecting portions of the book recount Gawande’s experiences with family members. Gawande related details of his grandfather’s old age, which seems idyllic to those who long for the old days of extended families caring for each other their entire lives. Sitaram Gawande lived in India, with a son and his “small herd of children, grandchildren, nieces, and nephews nearby,” and was revered and supported until he died at the age of 109, when he hit his head falling off a bus.

Gawande makes the argument that with global economic development opening up opportunities, many people wanted to “escape the shackles of family expectation and follow their own path,” and that the older generation – contrary to myth – was not unhappy to see them go.

This, of course, increasingly brought up issues of care for the elderly, followed by a spate of nursing homes and retirement communities. Gawande writes that nursing homes, by necessity, focus on safety, often while neglecting issues of privacy, autonomy and stimulation.

Gawande argues convincingly that quality of life should be the goal for patients and their families, and goes on to discuss pioneering movements in hospice and nursing home care.

Gawande describes some innovators in the field, including Keren Brown Wilson, who opened what is generally known as the first assisted living facility in Portland, Oregon. Wilson’s vision was to provide a real home for those in need, where residents could make their own decisions while obtaining necessary care. The program was closely monitored by the state of Oregon, and Gawande writes that it “proved an unmitigated success.”

Another pioneer in elder care is Bill Thomas, who decided while serving as medical director of a nursing home in upstate New York that “the missing ingredient in this nursing home was life itself.” His ideas, including tearing up lawns and planting vegetable and flower gardens, bringing in dogs, cats and birds (with the attendant responsibilities), were radical at the time, but researchers studying the program over two years found that required prescriptions fell to half that of the control nursing home, and deaths fell by 15 percent.

Dipping again into his personal experience, Gawande related the story of his father’s sudden illness and death. Gawande’s father, a practicing urologist, began experiencing neck pains, determined to have been caused by a tumor growing in his spinal cord. At several points in the medical saga that followed, father and son discussed options – both for immediate action and future quality of life. Gawande asked his father what his goals were if his condition worsened and what trade-offs he was willing to make. After one discussion, “what we felt afterward was relief. We felt clarity.”

Gawande senior spent his last weeks in hospice care, after brutally honest discussions with doctors about drug reactions, prospects with and without treatment, time frames, etc.

Gawande seems to be a big proponent of hospice care and, referring to his father’s experience, writes, “Here is what a different kind of care – a different kind of medicine – makes possible.”

Gawande’s book is a call for changes in the basic philosophy of health care, but also brings home to the average reader the need for thoughtful – albeit ever-changing – decisions on end-of-life issues.

The book is available at the Coronado Center Library.