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Book Review Being Mortal: Medicine and What Matters in the End

What is the book Being Mortal about?

Atul Gawande is a practitioner, who has descended from a family of doctors. He is well informed about the achievements of modern medicine, which allow us to prolong our lives and defeat diseases that were considered incurable until now. As a result, we managed to push the boundaries of old age beyond 60-70 years. Nowadays, many people who watch their health and have access to high-quality medical care can work for up to 80 years or more. However, sooner or later we all enter that period of life, which we usually try not to think about.

We all live like we are immortal and we have an endless amount of time ahead. The feeling that we will live forever is especially typical for young people. However, as we age, we eventually realize that there is not that much time left for us, so we subconsciously try to spend it as best as we can. Unfortunately, our ageing bodies couldn’t care less about our big plans. Our bodies wear out: our blood vessels lose their elasticity, joints lose mobility, the brain loses its efficiency. No matter what kind of medical care do you get, these changes are inevitable.

Medicine can help only to some extent – therapies and surgeries, support from friends and family, hobbies and active social life can prolong your life for a certain period. But then comes a moment when the medicine is powerless, although we never want to admit this. In this case, the person goes to a home for the elderly. Those are modern facilities, equipped with everything a person of age might need and staffed with qualified medical personnel, trained to take care of elderly patients. It’s a massive improvement from miserable hospices, where older people used to spend their last days in the past. Probably, a nursing house is the best option, when the patient is slowly dying but is still alive.

In the book, Gawande, an Indian by origin, mentions his grandfather, Sitaram Gawande, who was a farmer and died at the age of 110. The writer’s grandfather was ahead of the huge Gawande family and was respected and loved until his last days. In his youth he inherited a small piece of land, he worked hard and made a fortune on his ground, he had a lot of children and lived there with them. He was the first to eat at the dinner, and he was the first to greet and to show respect. He worked on his land until the end of his days. Everybody asked for his advice on various important matters, such as marriage, property and so on.

Although, he was a stubborn old man: once he had a quarrel with one of his sons and walked many miles to the house of another son and lived there, refusing to return for months. His many grandsons and granddaughters adored him and would do anything for him. He died from hurting his head on the bus when he went to court to regulate the land dispute (again, he was 110 years old!). He lived his life as he wanted, and his family stayed with him until the very end.

Gawande points out that in the USA his grandfather would’ve been sent to a nursing home at the age of 70. Following the standards established by the Ministry of Health, if a person can’t eat, use a toilet and move by himself, he is no longer physically independent. If someone can’t buy groceries, cook, take medication, travel and manage their finances, it means that someone must take care of this person. You’d think that people in a condition like this would be happy to live in a modern and comfortable nursing home, where their children can visit them at any time.

However, seniors are usually reluctant to go there. How so? Gawande believes that in a nursing home a person becomes an inanimate object of care. He is supposed to do what he is told: take medication and follow the schedule. No one cares about his desires or opinion anymore. It’s humiliating to a person in any medical condition. Because of this, Gawande thinks that we should have a viable alternative to nursing homes.

There should be alternatives not only to care for the elderly but also to care for terminally ill patients. When people who fight cancer go through chemotherapy and radiation treatment, they’re rarely told that it will prolong their life for a year or two at best. Moreover, quite often such medical care does not affect whatsoever. Gawande says that the same thing applies to surgeries.

Very often patients are not provided with sufficient information about the possible consequences and side effects of medical treatment, which brings them even more suffering and worsens their already serious condition. The writer emphasized that patients should be warned about any possible consequences and that therapy may not help them at all. That would give them the opportunity to choose whether they want to undergo a bunch of exhausting medical procedures, rather than blindly follow the doctor’s instructions.

He uses a story about his father as an example of that. At the age of 70, he was diagnosed with a rare spinal cord cancer. He was offered to undergo any emergency surgical treatment. Being a doctor himself, Atum Gawande’s father refused the surgery, since it could lead to total paralysis. He decided to undergo surgery only when it would be essential because of acute pain or progressive ascending disease. Thanks to that, he lived a couple of good years filled with work, public activity, tennis and other hobbies. Eventually, he had to undergo surgery, and he died shortly after that. He was surrounded by the care of his family and friends until the very end, so he passed away in peace.

Gawande insists that we should allow euthanasia for terminally ill patients suffering from debilitating and ruinous diseases that bring nothing but pain to the person and his beloved ones. He believes that in such cases, the patient must have the right to choose. Sometimes it’s more humane to let someone go rather than try to fix an irreversibly broken and dying body and attempt to prolong life even in situations when it leads to nothing but suffering.

Gawande stresses out that the modern system of elderly care doesn’t work anymore. Nursery homes should be designed in a way that allows people to maintain their independence rather than become faceless objects. Apartments for seniors must provide something in between constant care and independent living, and such facilities already exist. Also, palliative care is becoming increasingly more popular. It helps terminally ill people to live the rest of their lives as they want to. Palliative care is aimed at alleviating the pain and suffering while assisting the patient in doing something that he has always dreamed of.

Summary and 8 Ideas of Being Mortal:

  1. The problems of ageing can’t be helped, but they can be managed to avoid the worst effects.
  2. Many doctors have no idea how to treat elderly patients since they’re dealing with complex effects of aging rather than with a single disease. Nevertheless, many people of age prefer to visit a general practitioner instead of a geriatrician.
  3. Elderly people need to feel that someone needs them
  4. The scariest part of ageing is not death, but a loss of independence and everyday lifestyle.
  5. Most modern nursing homes are not designed to meet the needs of patients.
  6. Homes for the elderly should resemble a real home.
  7. The main enemies of nursing homes’ inmates are boredom and loneliness, not diseases and disabilities.
  8. Terminally ill patients have much more important things to do rather than pointlessly prolonging their lives

Review Being Mortal

Atul Gawande’s work is a handy and different book. However, its subject might seem too dark for some people. Nevertheless, at its core, the book is filled with humanity, understanding, sincere desire to help and if not to save the lives of those in need, then at least reduce their suffering.

The death is inevitable. Many of us are worried about what will happen to the world when we are gone. The only chance to leave something after yourself and make your life and death meaningful is to become a part of something bigger: a family, a community, or a society in general. Otherwise, the dizzying pace of life will be too terrifying to cope with.

The writer does not give readers any ready-to-use instructions on how to reorganize the health care system so it would pay more attention to elderly and terminally ill people. He only speaks out his opinion and tells stories from his medical practice. Perhaps, these stories will help you to understand your elderly relatives better and reassess certain aspects of your own life. The book is sincere, albeit bleak at times.

Pros and Cons:

Essential and broad ideas, touching stories that will make you care, clear narrative.

Top 16 Recommended Biography

Despite many original ideas, the main topics of this book make it difficult to read.
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