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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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2,5051813,525 (4.44)450
  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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English (189)  Italian (1)  All languages (190)
Showing 1-5 of 189 (next | show all)
I bought this book a few years ago on the back of a number of CR recommendations, and then I have to admit I kept actively avoiding it. I was fearful of reading about death, and learning things about it which could then not be forgotten. Then my Dad got diagnosed with stage 4 Non-Hodgkin's Lymphoma, and I really didn't want to to read it then.

One year on since my Dad's diagnosis, for the time being we've moved on from the terrible emotional swings that accompanied the diagnosis, and I guess have reached some level of reluctant acceptance of the situation. I therefore decided that now's precisely the time when I really need to read this book, and so I've been beavering away at it on my commute, saving off-topic fictional novels for my bedtime reading.

My first surprise is that this book wasn't at all what I expected. I thought it was going to be largely about dying from start to finish, but a significant chunk of the book - perhaps two-thirds - was about elder care and what can make a huge difference to people's happiness and quality of life once they start to find it difficult to look after themselves and enter into that decline stage of life. I was incredibly inspired by this. I have to admit it's not something I've given a lot of thought to before, and ridiculous as it seems had assumed that sitting around in the same circle day in, day out was par for the course when you enter a nursing home. Gawande discusses various care centres where they've focused on ensuring that people still have a life with choices rather than being institutionalised to a care facility's regime, and it's really left an impression on me. I'm quite sure there's a lot more we could do in that regard in the UK.

It's only in the last third or so of the book that Gawande focuses more on dying itself, and the difficult medical decisions patients and their families face at this time. Gawande is admirably frank about the wrong way he has approached these discussions with patients in the past, often offering false hope via yet more treatments rather than having the difficult discussions about the reality of their stage of illness and what their real goals are for this last stage in their life. I appreciated his openness about the complexity of these choices, and how difficult his family found it to help his father make the right decisions when he was at this point, despite having 120 years of medical experience between family members.

My most important take away from this book was the need to really evaluate the cons of treatments under these circumstances, particularly the effect they can have on quality of life versus the quality of life that can be had through palliative care. Most interesting were the facts on how last chance treatments (such as more rounds of chemo, radiation therapy, etc.) can often kill someone quicker than hospice care. Also important was the honesty around how physicians are human beings who often find it hard to be as direct as they need to be about the reality of what their patients will face.

There are very difficult decisions for people to make when faced with a life-limiting illness. Is the dangled carrot of some extra time through horrendous treatment worth trading for possibly shorter but better quality of life through no treatment?

This wasn't a depressing read as I'd expected, although a few of the stories did make me well up. It was a very important read - honestly one of those books that I think most of us need to read once.

4.5 stars - refreshingly honest about what really matters in the end. ( )
  AlisonY | Oct 4, 2018 |
A surgeon shows how medicine has lost its way, trading extra weeks or months of life for quality of life now, and how necessary changes in the way medicine deals with terminal illness are coming about through the hospice and other movements.

Thoughtful and moving book. ( )
  Robertgreaves | Sep 19, 2018 |
Thought-provoking and moving. This should be required reading for ALL medical professionals. ( )
  somethingbrighter | Sep 11, 2018 |
Malcolm Gladwell mentioned the author in an interview and my doctor daughter confirmed that it would be a good book to read, as indeed it was. Although a surgeon, the author has been able to write about complex medical issues so that a layman can understand. The subject is made more poignant by the author's personal experience with the death of his father. It could be the most important book that any of us could read. ( )
  hellbent | Sep 9, 2018 |
This genre is so hot right now. But I appreciate any work done to forward the idea of a positive death we can get. Thinking about death in the abstract is easy, but really there can't be any knowledge gained until you go through a death yourself. ( )
  adaorhell | Aug 24, 2018 |
Showing 1-5 of 189 (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.
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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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