Sunday, January 18, 2015

Being Mortal: Medicine and What Matters in the EndBeing Mortal: Medicine and What Matters in the End by Atul Gawande
My rating: 4 of 5 stars

The title of Atul Gawande's book "Being Mortal" is a bit misleading. I expected that Dr. Gawande, whose book "Better" I rate very highly, will help me in the struggle with the concept of my own mortality. After all, I am 63. Yet the main topic of the book is something altogether different - Dr. Gawande writes about how we shouldn't and how we should care for the aged, the very sick, and the dying. He also writes about the gross unpreparedness of today's medicine and today's doctors to handle the process of dying. The society at large is totally not prepared either; the author writes "This is the consequence of a society that faces the final phase of the human life cycle by trying not to think about it."

Roughly a half of the book is about everything that is wrong about how we care for elderly people who are in their last stages of life, but not yet dying. Dr. Gawande writes about the horrors of nursing homes. So-called "assisted living facilities" are a much better concept yet the most sacred principle governing this country - greed - has managed to largely destroy or at least obstruct the idea.

The second half of the book is about how the doctors and other medical professionals should handle the process of their patients' dying. Dr. Gawande writes: "Medical professionals concentrate on repair of health, not sustenance of the soul. Yet - and this is a painful paradox - we [here, he means the society] have decided that they should be the ones who largely define how we live in our final days."

This is by far the deepest and the most interesting part of "Being Mortal". Dr. Gawande demonstrates that the medical profession's priorities are wrong. He writes "We think our [medical professionals'] job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive." The doctors should realize that the dying may have other priorities than just suffer horribly a few weeks longer. The author writes: "[...] our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one's [life] story is essential to sustaining meaning in life [...]

Dr. Gawande raises many, many more important topics. He writes about hospices and makes a convincing argument that dying at a home-based hospice is better for people than dying in an ICU. He emphasizes palliative care. I am deeply impressed by the author's repeated references to Leo Tolstoy's novella "The Death of Ivan Ilyich" (one of the best books I have read in my life). "Being Mortal" is a provocative book (thanks for that!), full of wisdom about things that we do not really want to (but should) think about.

Four and a quarter stars.

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