★★★★☆ | Science | Digital | Borrow | StoryGraph | Goodreads
A sobering look at the inevitable and merciless certainty of our mortality. No matter how much we exercise or how carefully we eat, death is unavoidable. Further, the process of getting old is not for the faint of heart. A quote from Philip Roth starkly clarifies our predicament: “Old age is not a battle. Old age is a massacre.”
The point of Being Mortal is not to frighten, but instead to invite us to open our minds about a topic most of us would rather ignore. Alongside his talents as a writer, Gawande is foremost a practicing surgeon. He uses his personal medical experience to help us think ahead about our eventual demise. His advice runs contrary to the medical establishment. Doctors are good at fixing specific ailments, he says, but often do more harm than good with a dying patient.
Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days.
The book uses first-hand accounts of how patients faced their final days and weeks to illustrate the importance of these end-of-life choices. Many exhausted every possible medical intervention for the outlier’s chance of a cure, sacrificing the time they had left for painful and risky surgeries. Others, including Gawande’s own father, chose to focus on comfort and time with loved ones. This often meant choosing hospice care over further medical procedures.
Those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer. In other words, our decision-making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.
This is not an easy book to read, especially if you’re approaching the sunset years as I am. Yet, the lessons shared are essential to understand, both for ourselves and our friends and family. None of us are getting out of this alive. Gawande has given us some clear-eyed advice on how we can still make the best of it.
Highlights
The body’s decline creeps like a vine. Day to day, the changes can be imperceptible. You adapt. Then something happens that finally makes it clear that things are no longer the same.
It is not death that the very old tell me they fear. It is what happens short of death—losing their hearing, their memory, their best friends, their way of life. — Philip Roth
Your chances of avoiding the nursing home are directly related to the number of children you have, and, according to what little research has been done, having at least one daughter seems to be crucial to the amount of help you will receive.
“We want autonomy for ourselves and safety for those we love.” That remains the main problem and paradox for the frail. “Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.”
The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don’t, mortality is only a horror. But if you do, it is not.
As people’s capacities wane, whether through age or ill health, making their lives better often requires curbing our purely medical imperatives—resisting the urge to fiddle and fix and control.
25 percent of all Medicare spending is for the 5 percent of patients who are in their final year of life, and most of that money goes for care in their last couple of months that is of little apparent benefit.