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

by Atul Gawande

Other authors: See the other authors section.

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2,7861943,164 (4.45)476
  1. 00
    Final Exam: A Surgeon's Reflections on Mortality by Pauline W. Chen (BookshelfMonstrosity)
    BookshelfMonstrosity: Written by experienced and dedicated physicians, these compelling books question American health care's emphasis on management and technique to the detriment of human relationships between doctors and patients, especially when the patient's mortality is an important consideration.… (more)
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» See also 476 mentions

English (203)  Italian (1)  Hungarian (1)  All languages (205)
Showing 1-5 of 203 (next | show all)
This should be a must-read for anyone in the medical profession - and it would actually do everyone else some good as well! One of the central messages is that we (most of the world) have become a society that treats aging and death as medical "conditions" when they are instead normal aspects of life. He shows that our individual ability to choose our path and make our decisions is paramount to being human - that we should have a say in how our stories end, because the human mind looks at life as a story. And in all stories, the ending matters. ( )
  LisaBurns1066 | Jun 9, 2019 |
A modern and broad-ranging experience of mortality and how medicine has changed this, or not.
  LibraryPAH | May 8, 2019 |
Here's a quote, we have "priorities beyond being safe and living longer." He is not talking about assisted suicide, but about assisted living, which is more difficult. How can we enable agency?
Reading this wonderfully constructed book helped me in reflecting on my father's death during this year anniversary. ( )
  MaryHeleneMele | May 6, 2019 |
The author, a general surgeon, has spent his professional career trying to do what he was taught: fix his patients physically. Quantity of alternatives, not necessarily quality of life. It was assumed that longevity was worth any inconvenience and pain. A few years ago he began researching end-of-life care options with the goal of improving the lives of his elderly and end-stage patients. He consulted patients, geriatricians, pioneers in independent care programs, and hospice organizations, and provides the reader with a look at traditional nursing homes (and their history), home care and institutional alternatives, and trade-offs made by patients and families. His own father's illness and death provided him with a chance to put to use some of the techniques he'd learned.

The nursing home chapters describe typical (and nightmarish) conditions, and it was all I could do to continue. But once the book turned to the alternatives being developed, I found myself less traumatized thinking of my own future. While traditional medical care might stress the goal of prolonging lives, this often leads to situations that are the opposite of what patients really want, which is, typically: avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. (These issues become priorities not only to old people but to younger people who find themselves facing illness and end-stage disease.) In nursing homes, where the emphasis is on keeping patients physically safe, patients can feel imprisoned, without privacy or the right to make decisions about how to spend their time and with whom.

Doctors are traditionally trained to offer fixes, including those which are more and more experimental or unlikely to help. They are not taught to suggest there might be more meaningful alternatives, and sometimes the end of treatment. The author learned to ask very ill patients several questions, which even he, with all his new knowledge and desire to improve matters, found extremely difficult to do:

At this moment in your life:
1. What do you understand your prognosis to be?
2. What are your concerns about what lies ahead?
3. What kinds of trade-offs are you willing to make? How much are you willing to go through to have a shot at being alive, and what level of being alive is tolerable to you?
4. How do you want to send your time if your health worsens?
5. Who do you want to make decisions if you can't?

I was profoundly moved by the range of these questions and the responses they elicited. Clearly, patients aren't always thinking about the same things as other patients, or their families, or their health care workers. One striking result was that that families and doctors, finding themselves at a crisis moment in the patient's life, didn't have to make the hard decisions - the patients had already said what they wanted.

An excellent overview of possibilities for anyone concerned with these issues. ( )
1 vote auntmarge64 | Apr 11, 2019 |
An interesting book about how people age, how people care for aging people (or don't), what choices are available in cases of life-threatening illness (not just in old age), what should guide you in making those decisions. Atul Gawande encourages you, and helps you, to think about what will happen in old age and how to make choices. It is both harrowing and reassuring. Case studies, combined with medical science, combined with personal experience. ( )
  ReadMeAnother | Apr 2, 2019 |
Showing 1-5 of 203 (next | show all)
His new book, “Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death.

It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.”
added by melmore | editNew York Times, Sheri Fink (Nov 6, 2014)
 

» Add other authors (3 possible)

Author nameRoleType of authorWork?Status
Atul Gawandeprimary authorall editionscalculated
Petkoff, RobertNarratorsecondary authorsome editionsconfirmed
Pradera, AlejandroTranslatorsecondary authorsome editionsconfirmed
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Epigraph
I see it now—this world is swiftly passing.
—the warrior Karna, in the Mahabharata

They come to rest at any kerb:
All streets in time are visited.
—Philip Larkin, "Ambulances"
Dedication
To Sara Bershtel
First words
I learned about a lot of things in medical school, but mortality wasn't one of them.
Quotations
Modern scientific capability has profoundly altered the course of human life. People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical profession have proved alarmingly unprepared for it.
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. If end-of-life discussions were an experimental drug, the FDA would approve it.
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don't want a general who fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can't, someone who understands that the damage is greatest if all you do is battle to the bitter end.
… our driving motivations in life, instead of remaining constant, change hugely over time and in ways that don’t quite fit Maslow’s classic hierarchy. In young adulthood, people seek a life of growth and self-fulfillment, just as Maslow suggested. Growing up involves opening outward. We search out new experiences, wider social connections, and ways of putting our stamp on the world. When people reach the latter part of adulthood, however, their priorities change markedly. Most reduce the amount of time they spend pursuing achievement and social networks. They narrow in. Given the choice, young people prefer meeting new people to spending time with, say, a sibling; old people prefer the opposite. Studies find that as people grow older they interact with fewer people and concentrate more on spending time with family and established friends. They focus on being rather than doing and on the present more than the future.
Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.
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Amazon.com Product Description (ISBN 0805095152, Hardcover)

In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

(retrieved from Amazon Thu, 12 Mar 2015 18:25:46 -0400)

Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families of the terminally ill.

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