Book Review: Being Mortal
Medicine and What Matters in the End
By Atul Gawande
With Medicare and modern medicine, we’re worlds away from the poorhouses of 19th century novels, where the infirmities of old age left thousands to die in horrific circumstances. But as author Atul Gawande, a Harvard-trained surgeon and a staff writer for The New Yorker, shows in his new book, Being Mortal: Medicine and What Matters in the End, the modern response to debility and dying is often only marginally more humane and dignified.
Americans—and others in advanced societies—rarely care for aging family members at home, leaving the task to nursing homes and assisted living facilities that strip people of their privacy and independence in the name of safety and for the convenience of the doctors and staff. But, Gawande asks, what is life worth without a sense of purpose?
Gawande recounts the story of a New York nursing home whose severely disabled elderly residents seemed despondent and depressed until an innovative medical director added several dogs and cats to the mix and placed birdcages in residents’ rooms. Given responsibility for other living creatures, residents’ lives took on new meaning and the lights in their eyes turned back on.
Gawande paints a stark picture of how we die in the United States. Almost 30 percent of Medicare expenditures are racked up in the last year of life, frequently on futile treatments that do not cure patients but only prolong suffering. It seems neither doctors nor patients know when to stop.
Yet, Gawande finds, terminal patients who opt for hospice care often die more peacefully, allowing more meaningful time with the people they care about and less traumatic goodbyes. Additionally, data show, most live longer than those for whom every desperate measure was taken. Instead of insisting on the best that medicine has to offer, Gawande suggests a new paradigm—basing treatment decisions on whether they provide patients the best shot of maintaining a life that is worthwhile in their remaining days.
With The Checklist Manifesto, Gawande helped popularize the use of checklists, which have wrought minor miracles in patient safety here and around the world. One can only hope that Being Mortal has the same galvanizing effect on bettering the process of death.