Review: Being Mortal: Medicine and What Matters in the End

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

This is a book whose pages overflow with wisdom on how to view death - that insistent, inevitable, and, so far, undefeated foe.

Gawande goes where few can follow without great discomfort, without experiencing a malaise in morale. Well, it is still a very worthy read. Death is an experience that will come to each of us. It seems sensible to consider what medicine can do, what medicine should do, what medicine cannot do, and what we will actually want done when the time comes.

He details the history of how countries and civilizations deal with the very old, the sick, and the infirm - from the almshouse to hospitals, to nursing homes and assisted living. He offers the reader abundant examples of the many people he has known; people he has followed into their old age and their diminishment. This is very effective, as the reader gets to know these charming, feisty individuals. We follow them, their families, their treatments, their time in assisted living facilities and their eventual deaths. The role of medicine in this process is disturbingly uncertain and ineffectual.

At one point he talks about the fact that older people are generally more satisfied with life - the research reveals that they are not (as a rule) unhappy. It's almost as if living life is a skill and the longer you live the better you get at this skill. However, when it comes to death, maybe because it is something we only experience once, most of us aren't very skilled at it. His books pushes the reader to rectify this by getting more familiar with the complexities of letting go. Most of us will live long enough to become infirm in a dozen different ways. Must we all wait until it happens to think through it? Wouldn't it be better to continue to be the author of our lives until the very end, rather than allow ourselves to be infantilized by medicine and institutions?

Gawande believes that modern culture has made it very difficult to talk about death. He points out that culture is the sum total of shared habits and expectations. Those habits and expectations have resulted in a singular focus on safety and institutional routines in care facilities at the cost of the inhabitants being able to live a good life ... a life worth living.

This is a profoundly important book that asks all of the right questions about why we should focus on a good life, right up to the end.

“The battle of being mortal is the battle to maintain the integrity of one’s life—to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be.”

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