"Being Mortal" by Atul Gawande

To read Atul Gawande’s powerful bestseller “Being Mortal” (2014) is to engage in an unflinchingly honest discussion with a brilliant, but humble, doctor about end-of-life issues. Not everyone may be ready for that. It’s easy to put off thinking about the complicated choices we may face, given the medical advances that now exist to prolong life. But as Gawande reminds us, we will someday need to confront them for family members and ultimately ourselves. A death certificate requires just one cause of death, as if people are swiftly felled by one trauma. The truth, he says, is that it’s actually “the accumulated crumbling of one’s bodily systems.” A noted physician, responding to Gawande’s question about how to characterize death’s arrival, told him, “We basically all fall apart.”

That down-to-earth description leads to an examination of how prepared our society is, and we as individuals are, to face the reality of an often slow decline. Nursing homes, you might guess, are the answer. Though nursing homes satisfy societal needs, they are not made for what people need, and therein lies the heart of this book. Gawande asserts that the goal that should matter is, how to make life worth living when we’re weak and frail and can’t fend for ourselves. The lack of privacy, the inability to make personal decisions and the loss of familiar people and surroundings that generally go with nursing homes are the opposite of what people really want.

We get a look at what innovators in the elderly care business are doing to address that. Keren Brown Wilson first came up with the concept of an independent living center with assistance. In her Park Place in Portland, residents lived in small apartments, where they brought or purchased their own furniture, had locks on their doors, kept pets and had a nurse available on site at all times.  He reports that early assisted living facilities were meant to serve people until the end of their lives, but they have become more of just a step between independence and nursing homes.

Gawande closes by recounting personal experiences with his father at the end of his life. The young doctor was forced to draw upon what he has learned, not from medical school or fellow physicians, but from hospice caregivers and palliative-care workers who strived to make his father as emotionally comfortable and pain-free as possible. For a physician who once dismissed the concept of hospice care, he has become an ardent supporter.

Gawande says his goal for writing ‘Being Mortal” was to raise the issues and start a conversation. He certainly left me thinking and talking to others at length about these important topics. It’s a must read for those ready to address the uncomfortable but unavoidable idea of end-of-life care.