Being Mortal

It is not often I read a book I don’t “enjoy” but I keep going all the way to the end because it forces me to be reflective and think about things I would rather avoid. Being Mortal by Atul Gawande is one of those books. Gawande is a surgeon reflecting on how the medical profession approaches situations that may well lead to end-of-life scenarios. One of the main points of the book is that the advance of medical technology has made all of us try to avoid the important conversation of mortality, and that modern (more affluent) society has oftentimes focused on “staying alive” rather than living (and dying) well.

Here’s an excerpt from the last chapter that hits many of the main points. “Technological society has forgotten what scholars called the ‘dying role’ and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with their God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms. This role is, observers argue, among life’s most important, for both the dying and those left behind. And if it is, the way we deny people this role, out of obtuseness and neglect, is cause for everlasting shame. Over and over, we in medicine inflict deep gouges at the end of people’s live and then stand oblivious to the harm done.”

Gawande chronicles his journey thinking about this issue by reflecting on many interviews with patients, many of them ravaged by cancer, whose bodies are simply breaking down. He brings the reader into their lives and those of their family members – and the sheer difficulty many of them face is emotionally staggering. Threading through the book is the personal story of his father (also a doctor) who has the debilitating experience of aging catch up on him, like all other mortals. The book is also the reflection of a son experiencing those difficult decisions and conversations. One chapter of the book is devoted to “hard conversations” and why it is important to have them and how doctors need to consider how to approach. These are delicate and difficult, and Gawande discusses how he began to change his conversations with his own patients.

I learned a lot about nursing home, assisted-living facilities, hospice, and palliative care. There are many vignettes of people and places where living and dying well are first and foremost. These stories are encouraging, but the reader will find sobering how many places seem so much less that they could be – not because they don’t care about the patients and the ailing, but because the road is more difficult in many, many respects. Here’s an excerpt from an interview with assisted-living pioneer, Keren Wilson: “To genuinely help people with living is harder to do than to talk about… [in an] example of helping a person dress. Ideally, you let people do what they can themselves thus maintaining their capabilities and sense of independence. But… dressing somebody is easier than letting them dress themselves. It takes less time. It’s less aggravation… unless supporting people’s capabilities is made a top priority, the staff ends up dressing people like they’re rag dolls. Gradually that’s how everything begins to go. The tasks come to matter more than the people.”

That last sentence is a sober reminder not just to health-care workers but to all of us no matter what our profession. As a teacher, particularly approaching the beginning of a new semester, I have spent the last week mainly thinking about the tasks I have to do to get ready, much more so than the conversations I’m going to have with my individual students and getting to know them. When things get busy, what’s the first thing to go? It’s not the tasks. Those all still need to be done. But it gets worse if you focus mainly on measurable things such as grades, homework and test scores, etc. Gawande recognizes this in the follow-up passage to the one quoted above.

“Compounding matters, we have no good metrics for a place’s success in assisting people to live. By contrast, we have very precise ratings for health and safety. So you can guess what gets the attention from the people who run places for the elderly: whether Dad loses weight, skips his medications, or has a fall, not whether he’s lonely. Most frustrating and important, Wilson said, assisted living isn’t really built for the sake of older people so much as for the sake of their children. The children usually make the decision about where the elderly live, and you can see it in the way that places sell themselves.” This short excerpt doesn’t do justice to the thoughtful way that Wilson talks about what ideal assisted-living should look like and where it falls short, and I recommend reading the full story in Gawande’s book.

I read Being Mortal quickly, over the course of two days. So instead of having a celebratory back-to-school Labor Day weekend, I’m in a sober and reflective mood. Especially since I’ve been struggling with some chronic health issues over the summer. Things are getting better, thankfully, but I’ve noticed after passing forty that inflammations can show up unannounced and take longer to heal – and sometimes there is no apparent cause, or at least unclear to both the doctors and myself. It also made me reflect that I have not spend much time with the elderly since moving far away from home (internationally) for college and career. I grew up watching one set of grandparents ail and pass away in my own home, but I have missed many a funeral from older generations of people who were hale and healthy adults when I was a child. So it is with sobering “gladness” that I read Being Mortal. We should all be so reminded.