Atul Gawande is an American Surgeon, writer for the New Yorker, and a public health researcher. He practices general and endocrine surgery and has written four New York Times best sellers, the most recent being Being Mortal: Illness, Medicine and What Matters in the End.
Being Mortal had been brought to may attention some time ago when I attended an end of life conference; since then, I’ve heard it talked about in palliative care circles and so it seemed like something I should read. After I completed this book, with a sigh of relief, I tweeted that this wasn’t an easy read, although it’s fairly essential for anyone working in oncology, elderly care, or palliative care.
This book is split broadly into two halves. The first focuses on how the elderly population is cared for when they can no longer care for themselves — particularly in their own homes. Gawande gives many examples of those who have benefited from innovative care centers as well as the type of care that shifts from the standard care given in many nursing homes and in around the world. The second part of the book (and the part that I found most interesting) focused on how people with illnesses are cared for, specifically illnesses that are terminal, as well as the approach that is given to them, including medicine, nursing, and palliative and end-of-life care.
“Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.”
This book made me both nod madly in agreement and cringe in equal measure. I cringed because, as a provider of healthcare to those who are dying myself, so much of what I read is what I see happening in our hospitals and community practices every day. We don’t allow people to die. And when we do, for many, this is seen as some kind of failure. Even when that death is a release from the pain and misery of relentless, and often futile, treatment. Treatment may prolong life temporarily, but at what cost and in what form? I also know (and this is where the mad nodding happened) that much of what Gawande talks about does happen. There are many dedicated healthcare professionals, and not just in palliative care, who do believe in quality and comfort; who try daily to make sensible decisions with and for their patients; individuals who give their patients the time to talk about the future as well as what they might want to do when treatment no longer works and time is limited.
Gawande writes passionately; not just as a doctor, but as a son whose father died from a tumor of the spine. As such, he approaches the subject personally. He acknowledges the need for timely and honest communication with patients about what they want. He also recognizes that the hardest thing for many physicians is being brave enough to do “nothing”. I would agree with this but would also say that doing nothing in terms of treatment is actually doing something very active, especially when that “nothing” involves quality time to spend with loved ones, good symptom control, and putting the patient back in control. This book also illustrates how much pressure doctors come under from patients who expect that there will always be treatment available and death will never come. Just today I heard a family say “you must be able to do something.” Sometimes to do “nothing” does indeed take immense courage.
I would say to read this book. It may make you despair, but it may also make you think sensibly about your own future or the future of those you love. For one thing is certain: we are all mortal.
About The Author
Atul Gawande is the author of three bestselling books and 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.
Article by Angela Vincent Of Changing Pages | The Black Lion is a humble interdisciplinary journal that values your voice. Visit the submissions page to learn more about submitting to the Journal’s sections or to The Wire’s Dream Magazine. | Copyright Policy
Book image and author bio and image from Amazon. Header image from Changing Pages.