Books about death and dying are usually not on my list of “must reads.”
I couldn’t resist, however, the best-selling “Being Mortal: Medicine and What Matters in the End” (Metropolitan Books, 2014) by Atul Gawande.
Gawande is a practicing surgeon, professor of medicine at Harvard Medical School and the Harvard School of Public Health and the author of three popular medical books for laymen.
He has a provocative thesis that undoubtedly will be much discussed: Modern medicine is good at advanced treatments that prolong life among seniors and the terminally ill but poor at determining the quality of life such patients want at the end of their lives and helping them achieve their goals.
That “Being Mortal” is a compelling book to read and ponder is a testament to Gawande’s writing style and heavy use of examples.
The author first gives us a history lesson about how elders lived out their remaining years before the advent of modern medicine, using his own grandfather’s life in India as an example. But as people across the globe began to live much longer and with technology usurping the traditional role of the “wise elder,” seniors have found themselves less of a rarity and increasingly perceived as a burden on their families.
How has modern society reacted to this change in the United States? Gawande guides readers through the rise of the first nursing homes and how they developed rather unintentionally, as a way both to reduce overcrowding in hospitals and to take care of the poor. After the law that created Medicare passed in 1965, the number of nursing homes exploded. Unfortunately, “they were never created to help people facing dependency in old age. They were created to clear out hospital beds,” he writes.
There is good news, however. Across the U.S., individuals and small groups of concerned people are creating new types of living facilities for seniors and the terminally ill. Gawande gives many examples of such places and describes in detail how people are cared for in homelike environments. Keys to patient happiness, he claims, include a private room with a lock on the door and access to services and medical care as needed.
But what isn’t provided is important as well – patients are allowed to make decisions about their lives, even when those decisions may be poor – such as eating candy when they are diabetic.
The most important lesson in the book is from the section on having a conversation with a senior or someone who is terminally ill about what is important to him or her during the last stages of life.
Gawande argues that American doctors are not trained to conduct such conversations with their patients. Rather, physicians tend to stick to discussing treatment options, even when the options may be of dubious value to the patient. In fact, doctors tend to understate the risks associated with these procedures, he asserts.
Another important step patients can take is to find a physician who uses a “shared decision-making” process – a doctor who provides information and guidance and “deliberates with people on their larger goals,” according to Gawande. What is most important to the dying in their remaining days? It is a simple question, yet one not often asked – or not asked soon enough.
“Being Mortal” is an important book that all book clubs – and those facing their twilight years or with aging family members – should find value in.
Leslie Ashmore is a Mountain View resident who belongs to two book clubs.