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Being Mortal Illness, Medicine and What Matters in the End Paperback
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- LanguageEnglish
- PublisherPicador USA
- Dimensions5.4 x 0.8 x 8.2 inches
- ISBN-101250081246
- ISBN-13978-1250081247
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Product details
- Language : English
- ISBN-10 : 1250081246
- ISBN-13 : 978-1250081247
- Item Weight : 5.6 ounces
- Dimensions : 5.4 x 0.8 x 8.2 inches
- Best Sellers Rank: #637,042 in Books (See Top 100 in Books)
- #112 in Hospice Care
- #277 in Health Policy (Books)
- #446 in Sociology of Death (Books)
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About the author

Atul Gawande is the author of three bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist Manifesto. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker since 1998, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won two National Magazine Awards, a MacArthur Fellowship, and been named one of the world's hundred most influential thinkers by Foreign Policy and TIME. In his work as a public health researcher, he is Director of Ariadne Labs a joint center for health system innovation. And he is also co-founder and chairman of Lifebox, a global not-for-profit implementing systems and technologies to reduce surgical deaths globally. He and his wife have three children and live in Newton, Massachusetts.
You can find more at http://www.atulgawande.com.
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Being Mortal essentially provides a long, thoughtful, multi-faceted, historically-grounded complaint about the medicalization of aging and death, from someone who really knows and cares. Older adults may become less capable of caring for themselves in various ways, but for the most part they still want the things they always wanted: autonomy in their schedules and surroundings, community, privacy, a specific and concrete reason to get up in the morning. It’s a hell of a demand, to ask people to adjust to completely new surroundings and routines when they’ve never been older and/or sicker.
Institutions like hospitals and nursing homes are sort of good at providing some things (specific instances of treatment) and terrible at providing others (emotional warmth, exceptions to the rules, etc). The “assisted living” concept has an interesting history (read it in the book!). Unfortunately, by now assisted living has become a watered-down way station between hospital and nursing home, rather than remaining a bastion of alternative values in elder care as originally conceived.
Indeed, the logic of institutions is largely inexorable. If providing meaning (or a lifestyle ripe for it) cannot be measured and incentivized, it will not be reliably or scalably produced.
Admittedly, Being Mortal raises more questions than it provides answers. Everyone loves a good news story about kindergarteners who visit nursing homes. But are they changing diapers? Is there really any feasible model for caring for a rapidly aging population other than institutions? And how are you supposed to reward institutions for preserving meaning (an inherently individual task) even while they do the things that institutions are meant to do – get a lot of services provided quickly/reliably in a standardized fashion?
No individual person can change the system anyways, but it does seem that (even within the system we’ve got) people are making some crap decisions. Ok, so people are valuing the wrong things – namely, safety over autonomy and the “lottery ticket” of survival/recovery over a better death, sooner. You’re someone who wants to value the right things. So what do you do?
You have to do your own research and ask doctors hard questions, because they don’t really like facing imminent death either. You have to broaden your imagination about what acceptable living arrangements for an older person might look like.For instance, maybe you have to accept that your loved one might not get medicine exactly on time or the diet just as the doctor prescribed, because he’s going to sleep in his own bed and raid his own fridge instead. But maybe people don’t want to do those things. Then what?
That brings us to my main quibble with Being Mortal: Gawande waffles a bit between what people do value and what they should value. It’s so tempting to talk a big game about what “matters.” But if something really matters, why don’t people choose it? Don’t lots of different things matter? And how could it ever be anything less than very difficult to switch from life mode (focus on safety and the long-term) to end-of-life mode?
Perhaps Gawande ought to have sought out some different examples of these values in action. It’s not too hard to imagine a terminal patient forgoing last-ditch treatment, even if it’s not what we’d choose ourselves. It’s much more difficult to imagine a role model of, for instance, an adult child allowing her parent to live in what are widely considered to be “unsafe” living conditions specifically for the sake of that parent’s broader well-being.
I want to see examples of real “free-range” senescence. I’d like to read the account of someone who got a call from the police, who found mom passed out in the yard, or even whose parent died in an accidental house fire or something.
Many worst-case scenarios (of elders living unaided) will not come to pass, but some certainly will. Then what? Does that change people’s minds, one way or the other? Like trendy “free-range parenting,” it’s probably just much easier said than done. Does that mean a value is going unrealized, or that the person doesn’t hold it in the first place?
Maybe many patients don’t even know what they value the most. That’s fair, and part of what palliative care can help them to define, as it becomes increasingly relevant. But maybe there’s nothing satisfying to uncover. There’s no rule that everyone must necessarily value different components of life in a stable fashion. Some people will have very consistent desires, but others will vacillate (especially as they experience the stages of progressing towards death). If you draw a patient’s attention to the dangers of her living independently, she shudders. But when you tell a sad story about a nursing home, she cringes. Maybe she fights with her adult children about where she should go. Maybe she can’t afford her first choice. But that’s simple interpersonal conflict and lack of resources, not unique to old age.
You can’t live both independently and in a nursing home. Something’s got to give, and that totally sucks. Some values will be pursued better, and some values will be pursued worse, and some kind of balance must be reached. Care institutions put a finger on the scale, but they didn’t create the problem.
The personal economy of value pursuit is simply tricky, from the day we’re born until the day we die. Gawande knows that there are costs associated to the “old” way of dying – it tends to create autonomy for elders at the expense of the younger generation, especially women sandwiched between their children and parents. Many children (and parents) aren’t happy with this anymore, for a variety of reasons, so they face new sets of options (i.e. tradeoffs). Having access to medicine is a double-edged sword, and like many historically-novel conditions humans aren’t inherently well-equipped to deal with it. There’s no technocratic solution to that. If “dying as we lived” is some kind of standard for how we should go, then maybe alone and medicalized makes some sense right now after all.
I don’t really have any caveats in recommending this one, though. Just read it (and then try to forget Gawande’s description of how aging bodies feel in a surgeon’s hands as quickly as possible).
Book #3 for read about death dot com
You would think that when your daughter-in-law encourages you to read a book—you would read it. Ditto book recommendations from your wife.
Melinda and Joanne—sorry it took me a year to read this. But thank you. Because “Being Mortal” is now on my Top-10 book list for 2018.
In this riveting book, Dr. Atul Gawande reminds us: “People die only once.” So when facing fork-in-the-road sick and dying decisions, “They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and escape a warehouse oblivion that few really want.”
“Being Mortal: Medicine and What Matters in the End” changed—totally changed—my thoughts about end-of-life decisions. Whew. On one level, I agree that this New York Times bestseller (7,000 reviews on Amazon!) is a brilliant and deep look at the “…still unresolved argument about what the function of medicine really is—what, in other words, we should and should not be paying for doctors to do.” Yet on another surprising level, this writer (four bestsellers), surgeon, and public health leader—delivers fresh management and leadership insights in every chapter.
CUSTER OR ROBERT E. LEE? The author says that medicine’s job is to fight death and disease—the enemy—but that the enemy eventually wins. “And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.”
Yet Gawande admits, “More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, ‘You let me know when you want to stop.’ All-out treatment, we tell the incurably ill, is a train you can get off at any time—just say when. But for most patients and their families we are asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve.”
What should families do? My suggestion: ask your doctor (like I did this week) if he or she has read “Being Mortal.” (He had.) Gawande notes that medical school taught him two styles of doctor/patient interactions: paternalistic and informative.
The “paternalistic relationship” is the “priestly, doctor-knows-best model, and although often denounced it remains a common mode, especially with vulnerable patients—the frail, the poor, the elderly, and anyone else who tends to do what they’re told.”
Doctors make the critical choices. “If there were a red pill and a blue pill, we would tell you, ‘Take the red pill. It will be good for you.’ We might tell you about the blue pill; but then again, we might not.”
The “informative relationship” sounds good, at first. “’Here’s what the red pill does, and here’s what the blue pill does,’ we would say, ‘Which one do you want?’ It’s a retail relationship. The doctor is the technical expert. The patient is the consumer.”
The down side? Doctors become “ever more specialized” and “We know less and less about our patients but more and more about our science.” He writes, “In truth, neither type is quite what people desire. We want information and control, but we also want guidance.” In his medical school, there was also the brief mention of a third type of doctor-patient relationship often labeled “interpretive.”
“Here the doctor’s role is to help patients determine what they want. Interpretive doctors ask, ‘What is most important to you? What are your worries?’ Then, when they know your answers, they tell you about the red pill and the blue pill and which one would most help you achieve your priorities.”
Makes sense right? Gawande notes that this relationship is also called “shared decision making” and added, “It seemed to us medical students a nice way to work with patients as physicians. But it seemed almost entirely theoretical. Certainly, to the larger medical community, the idea that most doctors would play this kind of role for patients seemed far-fetched at the time. (Surgeons? ‘Interpretive?’ Ha!)”
But two decades later, the author describes a meeting with his father (also a surgeon) and his father’s neurosurgeon. The task: review the MRI images of his father’s giant and deadly tumor. The neurosurgeon “saw himself as neither the commander nor a mere technician in the battle but instead as a kind of counselor and contractor on my father’s behalf. It was exactly what my father needed.”
To get the conversation going in your family, maybe insert a reminder into your Thanksgiving prayer next Thursday that everyone around the table will die only once! Then, mention this book as required reading for at least one family member. (“Grammy—please pass the turkey and that Being Mortal book.”)
Dr. Gawande is an amazing writer. The poignant stories are page-turners. The innovative solutions—inspiring and encouraging. I’ve already re-told many of the memorable fork-in-the-road stories (tears will flow) to friends and colleagues and ordered the book for several friends. Be sure to read the hilarious story of the very creative nursing home that added two dogs, four cats, and 100 parakeets! (Memo to Purchasing: Next time, order the cages before the birds are delivered!)
I should have jumped on this 2014 book much, much sooner—because I still rave about Gawande’s 2010 insightful bestseller, “The Checklist Manifesto: How to Get Things Right.”
I had no idea that there were checklist connoisseurs! “The Checklist Manifesto” moves eloquently through medicine, aeronautics, and sky-scraper construction—noting why checklists will make or break a venture. For example, Boeing’s checklist expert uses “pause points” when designing checklists for pilots in crisis. Within each pause point, he limits the checklist to between five and nine items.
As a staff writer for the New Yorker, Gawande’s latest article, “Why Doctors Hate Their Computers,” was published on Nov. 12, 2018. You can read or listen to the article online. (Customer Bucket Pop Quiz: Are computer systems for the doctors or for the patients?)
And—get this—Gawande is also CEO of the health care venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase to deliver better outcomes, satisfaction, and cost efficiency in care. Stay tuned!
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そして死にゆくこと
それがどういう意味を持ち
どういう選択が残されているか
全ての人が考えるべきテーマ だと思う
Tema pra lá de pertinente com abordagem sensível.




















