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Being Mortal: Medicine and What Matters in the End Hardcover – Deckle Edge, October 1, 2014
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An Amazon Best Book of the Month, October 2014: True or false: Modern medicine is a miracle that has transformed all of our lives.
If you said “true,” you’d be right, of course, but that’s a statement that demands an asterisk, a “but.” “We’ve been wrong about what our job is in medicine,” writes Atul Gawande, a surgeon (at Brigham and Women’s Hospital in Boston) and a writer (at the New Yorker). “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.” Through interviews with doctors, stories from and about health care providers (such as the woman who pioneered the notion of “assisted living” for the elderly)—and eventually, by way of the story of his own father’s dying, Gawande examines the cracks in the system of health care to the aged (i.e. 97 percent of medical students take no course in geriatrics) and to the seriously ill who might have different needs and expectations than the ones family members predict. (One striking example: the terminally ill former professor who told his daughter that “quality of life” for him meant the ongoing ability to enjoy chocolate ice cream and watch football on TV. If medical treatments might remove those pleasures, well, then, he wasn’t sure he would submit to such treatments.) Doctors don’t listen, Gawande suggests—or, more accurately, they don’t know what to listen for. (Gawande includes examples of his own failings in this area.) Besides, they’ve been trained to want to find cures, attack problems—to win. But victory doesn’t look the same to everyone, he asserts. Yes, “death is the enemy,” he writes. “But the enemy has superior forces. Eventually, it 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.” In his compassionate, learned way, Gawande shows all of us—doctors included—how mortality must be faced, with both heart and mind. – Sara Nelson
“Being Mortal, Atul Gawande's masterful exploration of aging, death, and the medical profession's mishandling of both, is his best and most personal book yet.” ―Boston Globe
“American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande's most powerful--and moving--book.” ―Malcolm Gladwell
“Beautifully crafted . . . Being Mortal is a clear-eyed, informative exploration of what growing old means in the 21st century . . . a book I cannot recommend highly enough. This should be mandatory reading for every American. . . . it provides a useful roadmap of what we can and should be doing to make the last years of life meaningful.” ―Time.com
“Masterful . . . Essential . . . For more than a decade, Atul Gawande has explored the fault lines of medicine . . . combining his years of experience as a surgeon with his gift for fluid, seemingly effortless storytelling . . . In Being Mortal, he turns his attention to his most important subject yet.” ―Chicago Tribune
“Beautifully written . . . In his newest and best book, Gawande . . . has provided us with a moving and clear-eyed look at aging and death in our society, and at the harms we do in turning it into a medical problem, rather than a human one.” ―The New York Review of Books
“Powerful.” ―New York Magazine
“Atul Gawande's wise and courageous book raises the questions that none of us wants to think about . . . Remarkable.” ―John Carey, The Sunday Times (UK)
“A deeply affecting, urgently important book--one not just about dying and the limits of medicine but about living to the last with autonomy, dignity, and joy.” ―Katherine Boo
“Dr. Gawande's book is not of the kind that some doctors write, reminding us how grim the fact of death can be. Rather, he shows how patients in the terminal phase of their illness can maintain important qualities of life.” ―Wall Street Journal (Best Books of 2014)
“Being Mortal left me tearful, angry, and unable to stop talking about it for a week. . . . A surgeon himself, Gawande is eloquent about the inadequacy of medical school in preparing doctors to confront the subject of death with their patients. . . . it is rare to read a book that sparks with so much hard thinking.” ―Nature
“We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. However it is not only medicine that is needed in one's declining years but life--a life with meaning, a life as rich and full as possible under the circumstances. Being Mortal is not only wise and deeply moving, it is an essential and insightful book for our times, as one would expect from Atul Gawande, one of our finest physician writers.” ―Oliver Sacks
“Gawande's book is so impressive that one can believe that it may well [change the medical profession] . . . May it be widely read and inwardly digested.” ―Diana Athill, Financial Times (UK)
“Eloquent, moving.” ―The Economist (Best Books of 2014)
“A great read that leaves you better equipped to face the future, and without making you feel like you just took your medicine.” ―Mother Jones (Best Books of 2014)
“Beautiful.” ―New Republic
“Gawande displays the precision of his surgical craft and the compassion of a humanist . . . in a narrative that often attains the force and beauty of a novel . . . Only a precious few books have the power to open our eyes while they move us to tears. Atul Gawande has produced such a work. One hopes it is the spark that ignites some revolutionary changes in a field of medicine that ultimately touches each of us.” ―Shelf Awareness (Best Books of 2014)
“A needed call to action, a cautionary tale of what can go wrong, and often does, when a society fails to engage in a sustained discussion about aging and dying.” ―San Francisco Chronicle
- ASIN : 0805095152
- Publisher : Metropolitan Books; 1st edition (October 1, 2014)
- Language : English
- Hardcover : 304 pages
- ISBN-10 : 9780805095159
- ISBN-13 : 978-0805095159
- Item Weight : 13.6 ounces
- Dimensions : 6 x 1 x 8.5 inches
- Best Sellers Rank: #11,779 in Books (See Top 100 in Books)
- Customer Reviews:
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Top reviews from the United States
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There is a tendency to treat old people like children which I realize now is usually very wrong. My dad is a diabetic and we (my siblings and I) have told him over and over that his diet of sugary cereal or cinnamon rolls and orange juice for breakfast and light store brand fruit yogurt with grapes and three cookies for lunch is not what he should be eating. He acts surprised every time we mention this, but doesn't change a thing because I now understand that he wants the independence of eating as he pleases. He has lost so much--can barely hear or see or walk, that he needs these very small pleasures to continue. I imagine he doesn't see the point in giving up anything else because he has so little left. My mother's memory is going and she has COPD, but somehow has lots of get up and go. She does a lot for my dad even though I suspect she is the sicker one. Being Mortal is making me think about the best way to help my parents which will probably start with asking them what they want.
One thing that surprised me completely was Dr. Gawande's statement that genetics is only a small part of reaching old age. Here I've been thinking that because my parents have lived so long that reaching old age is probably a no brainer for me. I have to think about that possiblity some more--a lot more.
This book has some touching stories about very sick people and how their lives ended. Unfortunately for many sick people the medical community is driven to act, but not necessarily to do what is best for the individual. It seems to me that they've forgotten "the do no harm" part of being a doctor. It seems to me it does harm people to ruin the time sick people have left.
A very through provoking book that will ultimately make me think about what I want when the end is near. I wish everyone would read it; especially medical people.
One can see the signs of aging as they appear on the outside: gray hair, age spots, and wrinkles. Dr. Gawande, a surgeon, also shares what he sees when he peers inside the body of an older patient. Each day some parts of the body die and are remade while others wear and change with constant use. What happens when the limitations of one's aging body require a change in one's lifestyle? There are now many choices and Dr. Gwande rails against settling for just safety and longevity, institutionalization and restriction. He relates the history of nursing homes and visits first-hand the many options for living a life of privacy and community, of vibrancy and purpose. He applauds those in the field of gerentology who have thought "outside the box" for the development of active communities for those who are aged and frail.
The reader experiences the morphing of Dr. Gawande from a mere practitioner to the son of a dying parent. How does a doctor broach the difficult end-of-life options with terminally ill patients and loved ones? The menu of medical options for treatment can be insufficient and it is essential that the practitioner also ask the patient what she or he wants most in the finite time remaining. Is it a mistake to prolong suffering or is it better to provide value in a shortened life? The author suggests that courage is required for both aging and sickness: the courage to confront the reality of mortality and the courage to act on the truth of that reality. Have the courage and the wisdom, dear reader, to explore these difficult topics presented in the pages of this transformative book.
Top reviews from other countries
The book is just over 280 pages, split into eight chapters by subject.
I was slightly scared to read this book as I expected it to force me to confront emotions that I usually bury. And it's true that there were some very familiar issues dealt with regarding the quality of life and the moralities of the healthcare system forcing people to live longer than they actually should be able to.
The narrative is very easy to read . It is direct, not avoiding difficult subjects and discussing decline/death in the way that you would hope of a physician.
It should be noted that this is a US author so the statistics and examples are all from the US. The easiest way to approach this from the UK is assume that everything is the same here but, of course, that isn't necessarily true.
Many problems are raised with the system but, unsurprisingly, not too many solutions are discussed. It is never going to solve problems but will provoke thought which I think is its main purpose. The ideas that are raised are very plausible though and worthy of trying out.
There are many points in the book where the author theorises and I thought that it was much more effective when he used real examples to illustrate what he is trying to say.
He tackles geriatric care very openly but when he moves on to the mortality of terminally ill younger people the book becomes more controversial - money is always a limiting factor and we are asked to think about whether extending a life temporarily (and miserably) is sensible - he actually refers to this option being the "default choice" of many people in the medical world.
Being Mortal's main focus is on how medicine and medical care has maybe skewed our perception on what it means to live. Does the quality of the life we have at the end often get overshadowed by a focus of extending our life -- even if this extension comes at the cost of stripping our final days of everything that gives meaning to a definition of "Life".
The book begins by investigating the kind of care that is offered to our culture's elderly; a care that can, more often than not, remove as much of their autonomy and dignity as possible in favour of safety. The latter half of the book then moves into discussing the kind of medical direction that is adopted with/by those who are diagnosed as terminally ill.
In both cases, Dr Gawande, eruditely and with much sensitivity, proposes that a better kind of end-of-life-care would be given, and a better quality/freedom of life would be had, if we moved our focus away from trying to ward off the inevitable and placed it instead on assisting and cultivating what life there is remaining. Gawande's proposition is for a more considered medical approach towards those facing the final chapter of their story; one that would allow people to maintain as much control of their life as possible. In such cases the question is not a matter of "would we like to live or die", but what quality of life would we like to have available to us prior to the end, and what levels of quality are we prepared to "trade" in order to extend what little time we have left? The concern of medicine and care would therefore be more inclined in providing the patient with an attainable desired life and not putting them through unnecessary cycles of treatments which, inevitably, erode what quality of life could be had whilst giving so little time (if any) back in return. In such an application, the "well-being" (physically, mentally and emotionally) of the patient would be more important than treating the incurable.
In short, could our current medical practice (along with our own expectations of what medicine is for/about) be failing those who are facing death by preventing them from experiencing as much life as is possible in their final moments?
Such an approach does require us courageously accepting our own mortality; which is a modern challenge in the technological age we live in, and something our ancestors never really struggled with. But this acceptance would lead us towards embracing a life we can have now instead of forfeiting this for something that, sadly, lies beyond our reach.
At this point, some may be thinking that Being Mortal is about Euthanasia. Although this highly complex ethical issue is briefly discussed within the book's eighth chapter (entitled Courage), the context of the book is not arguing for prematurely bringing someone's life to close ("assisted dying"), but improving the quality of life for those who are terminal, and helping them to best prepare, both emotionally and physically, for this end. In other words, this book is arguing for "assisted living". That said, I'm certain that both sides of the Euthanasia debate would find much food for thought within Dr Gawande's writing, along with examples that could be taken to both strengthen and challenge their held positions. Personally, I'm not sure whether the topic under discussion within this book would fall under the header of Euthanasia; it could be argued that prolonging treatment to fight a terminal illness that has already won, could lead into an earlier death.
I found this book extremely fascinating, poignant and sobering. I'll admit, at the age of thirty-five, the quality of life I would desire at my own end isn't something I've given much thought to. I have now. Reading this book will certainly have that affect on you. But the book has also made me think a lot about others, especially the elderly I know and love.
Death, and preparing for it, is such a difficult topic to discuss. So I admire Dr Gawande's courage and compassion as he navigates this issue; and he navigates it very well. To help him in this task, many personal stories from those who have faced this natural crisis have been used; even Atul's own moving description of his father's last years. At first, I found some of the core issues raised by these stories repetitive; wondering whether they could have been condensed together. However, with the hindsight that birthed when I was about three quarters of the way through this book, I became very grateful for every syllable. These personal words help to enlarge our perception of what it means to live; they enable us to grasp how universal our hopes and fears are when it comes to preparing for the end of our own tale.
It is -- though it may seem a very awkward thing to read in public -- an excellent book. One that maybe we all should read.
-- Tristan Sherwin, author of *Love: Expressed*
As the author so succinctly puts it, specialist doctors now-a-days are trained to 'fix' a particular problem. Elderly patients suffering from multiple ailments are brought to a hospital by their anxious relatives. Once inside the hospital complex, the patient is taken over by a regimented system. He loses his autonomy. Human warmth is in short supply and there is a certain chill in the atmosphere. Doctors do not have the time or inclination to have detailed discussion with the patient or his relatives. The system is heavily weighed in favour of the service provider, i.e., the hospital administration, doctors, pharmaceutical companies, insurance companies etc. The service seeker is left at the mercy of the heartless system.
The title of the book reminds us that man is after all mortal. In many cases, hospitals prolong life unnecessarily, painfully and at an exorbitant cost. An old and infirm person prefers to spend his last days at a place that provides homely comfort and medical care at an affordable price. The author cites several innovative models being tried by people dedicated to the cause of alleviating human suffering.
'Being Mortal' had a profound impact on me partly because I happened to read it when I had not yet recovered from the shock of my eighty five old mother's painful death. She was quite healthy in body and spirit until she was eighty. Then she had a sudden fall and broke her hip bone. An operation was done on her and a metal plate was implanted. A walking stick enabled her to walk on the level ground with difficulty. Her confidence was shaken as she lost her mobility. She considered herself a burden on the family. She became morose. Members of the family had little time to waste on her. She spent the day sitting alone on a chair in a dimly lit room and looking vacantly at a T.V. set. She had become incontinent. She was afraid she might wet the bed. Having lost her autonomy, she slowly sank into an abyss of dreadful agony which was reflected in her melancholy eyes. She often asked me piteously, " How long have I to live like this?" I had no answer. One day she stopped talking and eating altogether. She was admitted to a hospital. Doctors diagnosed it was a case of aspiration pneumonia. The pneumonia was controlled. But she never regained her ability to talk, drink or eat. She was brought back home. She spent her last days confined to her bed with all sorts of tubes sticking out of her frail body. Early one morning death came as a relief to her pain and shame.
A year has passed since my mother's death. Meanwhile I read 'Being Mortal'. The book's message rattled me. Nothing is more precious to a dying person than a smiling face or a loving gesture. Did my mother receive it in ample measure during the last phase of her life? Doubts linger.