Book Review - Being Mortal

Atul Gawande, M.D., Being Mortal: Medicine and What Matters in the End
Metropolitan Books, Henry Holt and Company, 2014

Book cover artwork: A. Gawande: Being Mortal

This brilliant work shines bright new light on our declining years. As we grow old, we ask to be allowed to remain the writers of our own story. Unfortunately, that story is too often surrendered to a powerful medical care system with a narrow focus on the repair of the body, rather than sustenance of the soul. Atul Gawande so aptly writes: “We’ve been wrong about what our job is in medicine. We think…[it] is to ensure health and survival. But really…it is to enable well-being. And well-being is about the reasons one wishes to be alive.”

We all seek a cause beyond ourselves, and what we need are new initiatives that feed our souls as we age. Several of these projects, such as Bill Thomas' attack on the Three Plagues of nursing home existence -- boredom, loneliness, and helplessness, are put forth in detail.

The greater part of the book, however, is devoted to teaching us to raise four hard questions that we need to ask ourselves and our loved ones as the storm clouds of decline blacken around us. 

  1. What is your understanding of what is happening to you?  
  2. What are your fears about this?  
  3. What are your goals if your condition worsens? (One professor's only goals were to be able to eat chocolate ice cream and watch football.) 
  4. What tradeoffs are you willing to make and not willing to make to try to stop what is happening?  

These questions need to be asked repeatedly over time because the answers can and will likely change. The author recounts their usefulness as a way to lovingly shape the last years of his father's (who was also a doctor) life. He also uses this format to find soulful paths during the decline and dying of two of his patients.

You may need to start this conversation with your doctor, rather than waiting until he or she brings it up. Please be advised that it will require courage, defined as strength in the face of knowledge of what is to be feared or hoped, and the willingness to act on the truth we find. One has to decide whether one's fears or one's hopes are what matter most. With difficulty, I have begun to ask these questions of myself as well as my patients. However, once we begin to think about these questions, we’re likely to feel relief and clarity of purpose.

"Yea, though I walk through the valley of the shadow of death, I shall fear no evil." (23rd Psalm) This book gives us tools to deeply understand late life, contemplate our own mortality, . ~BWS