Sunday, February 03, 2019

Being Mortal by Atul Gawande

Being Mortal: Medicine and What Matters in the EndBeing Mortal: Medicine and What Matters in the End by Atul Gawande
My rating: 5 of 5 stars

Spoiler Alert: We’re all going to die.

For the majority of us that will come via the afflictions of old age or of some disease. How we, our families, our social framework, and the medical community deal with that inevitability is the basis of BEING MORTAL by Atul Gawande.

Gawande is a surgeon at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School and the Harvard School of Public Health. He is a director of Ariadne Labs, a joint center for health systems innovation, and chairman of LifeBox, a nonprofit organization making surgery safer globally.

Gawande walks his readers through the changing demographics influencing the landscape of care for the aged and the terminally ill. He covers the growth of secondary housing (nursing homes and assisted living centers) and the social aspects of who controls how residents interact with the world around them, how much autonomy residents have, and what is more important, safety or quality of life, for instance. He covers the development of advanced therapies for fighting cancers and how doctors must learn to decide when the best thing to do is nothing and how to communicate with families about those choices.

Gawande uses examples from the patients of other medical professionals, his own patients, and even his own father to illustrate the problems facing society today. How do you tell a patient that entering a nursing home is necessary for their safety when they are used to being independent? How do you encourage patients to consider end-of-life issues when they want to keep fighting a terminal disease in its later stages? Gawande is careful to relate that he struggles with these issues too, and the right solution is probably different for every patient and their family.

I lost my father to pancreatic cancer in 1988 and my wife to appendiceal cancer in 2015. Neither was a good experience, but the availability of hospice made having my wife at home in her last days of such value to her and our family. My wife’s passing was peaceful. My father spent the last three or more weeks of his life in a hospital bed and it was anything but peaceful.

BEING MORTAL is an important book that everyone should read. Gawande doesn’t purport to have all the answers, but he does lay out a pathway for each of us to follow in trying to do what’s right for ourselves or our family members. It is an essential tool for all of us.

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