02 Mar / Being Mortal: Medicine and What Matters in the End by Atul Gawande
Ah finally, I’m fully caught up with the good doc, having read each of Atul Gawande’s four bestsellers in published order. And how grateful am I to have followed through so methodically, because all that ‘homework’ certainly made this, his latest, an even fuller read.
Here’s an immediate example: Being Mortal begins with a story about a patient Gawande calls Joseph Lazaroff (he’s always careful about maintaining anonymity, as necessary). In the “Introduction” here, Gawande reveals reveals that Lazaroff was originally mentioned “in one of my first essays” which appeared in his debut, Complications. While the late Lazaroff’s diagnosis and outcome hasn’t changed, Gawande has had a dozen years of experience between writing these two titles; with such, Gawande is able to resurrect this case with sharper perspective and deeper insight that time and distance surely allows. Lazaroff’s mortality when Gawande was a junior surgical resident takes on different implications 12 years later as Gawande ponders “what matters in the end.”
Although ‘the end’ is featured prominently in these pages, Mortal is not so much about death, as it is about how we choose – or don’t/can’t choose – to live our final years. Rhodes Scholar/surgeon/professor/MacArthur “Genius”/New Yorker/TED-anointed Gawande again uses real-life story after story – again, including his own – to examine and illuminate the inevitable end of life. “I learned about a lot of things in medical school, but mortality wasn’t one of them,” Gawande muses. “The way we saw it, the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.” Gawande quickly realized “how unready [he] was to help” his patients and their families with facing the most difficult challenges of aging and dying. In our modern society where we are living longer healthier lives thanks to multiplying scientific advances, “mortality [has become] a medical experience” over the last decades. “As recently as 1945, most deaths occurred in the home”; in the industrialized world, the end is now most likely to happen in a hospital or nursing home.
“You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help,” he reveals. Keeping the elderly alive doesn’t always mean that they are living: “Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they need most.” Death is inevitable; aging begins the minute we are born. Just as science has made living better, understanding and compassion in addition to science, can make dying better, too.
From Gawande’s grandmother-in-law to his own father, from an octogenarian couple with a 60+ year love story to a young doctor who moved an animal menagerie into a nursing home, from a brand new mother with terminal cancer to a 74-year-old professor who was “‘willing to stay alive’” as long as he was “‘able to eat chocolate ice cream and watch football on TV’” (having never, ever watched a football game in his daughter’s memory), Gawande tells stories. In these stories are lives that end with regretful suffering, but more lives end with grace and peace. He gently examines methods – honest, difficult conversations need to happen before it’s too late – and shows alternatives – hospice care can prolong with comfort. He mixes in the data, numbers, science and more – his scientist training won’t let him do otherwise – but the stories are what inspire, linger, and teach.
Tidbit: As noted previously, this is Gawande’s fourth book: Complications, Better, The Checklist Manifesto, all led up to Being Mortal. In Chinese characters (also used in numerous written Asian languages, including Japanese and Korean), the number four and death are homophones – both are ‘shi.’ Just as you may not see a 13th floor in Western buildings, many in the East are without a fourth floor. With the influx of Western tourism and growing ex-pat communities, high rises in the East might even be missing both fourth and 13th floors (a popular hotel in central Seoul in that made-famous stylish neighborhood of Gangnam is one such example). I couldn’t overlook the irony of Gawande’s fourth book being about “the end.” More importantly, what can possibly come after “the end”? Dare I ask, what’s the good doc planning for his fifth book? Devoted (impatient) groupies gotta know …!!
Tidbit2: The legendary neurologist and bestselling author Oliver Sacks announced on February 19, that he has terminal cancer in this phenomenal letter. It is, in a sense, a goodbye to the rest of the world as he prioritizes the life he has left: “There is no time for anything inessential. I must focus on myself, my work and my friends.” He’s turning off the news and “no longer pay[ing] attention to politics or arguments about global warming. This is not indifference but detachment …” This could be a chapter right out of Being Mortal … another memorable lesson on “what matters in the end.”