Hits and Misses

Hits and Misses

Thursday, October 29, 2015

Atul Gawande's Being Mortal

The human condition is such that we all live with a contradiction.  Consider the Classical syllogism:  "All men are mortal.  I am a man.  Therefore, I am mortal."  When pressed, we reluctantly assent to its truth for our species, but nearly all of us refuse to believe it in our heart's core.  The eventuality of our own death is postponed, pushed off into the indeterminate future, far from now.  And even then, we fondly hope, a medical miracle may defeat death, if not forever, at least until we're really, really old.

Atul Gawande's Being Mortal:  Medicine and What Matters in the End (Metropolitan Books, 2014) goes a long way to blowing this fantasy out of the water.  Doctors are very skilled at performing operations to deal with specific problems.  But Gawande--a surgeon himself--points out that by recommending and performing these operations, doctors are being unwittingly cruel because their patients consent to them in the hope that they can continue to live longer--much longer.  The MD knows this is a stop-gap operation but doesn't want to depress the patient with that information.  The patient, meanwhile, is desperate to hold on to life, to do everything possible rather than "give up," and often doesn't want to disappoint the family.  Too often, this gap in communication remains unbridged.  The doctor does not admit that such surgery, even if successful, will only extend the patient's life a relatively short time and may well make the patient's quality of life even worse.  The  patient, on the other hand, never divulges to the doctor that the additional span of life being hoped for is on the order of twenty years

Being Mortal casts a wide net, covering the historical reasons why hospitals became the place to die and how they have begun to be succeeded by hospices, which offer palliative care focused on a patient's quality of life.  What sets Being Mortal apart, however, is less its analysis of the medical practices involving the terminally ill than its empathetic exploration of what happens when individuals approach the end.  Among other things, this is a book about specific individuals, and Gawande makes every one of them memorable.  Gawande is refreshingly candid about how difficult it is to engage in straightforward, honest conversations with a dying person.  Although I don't believe he ever uses this term, Gawande argues for a collaborative model of care for the terminally ill. The doctor not only provides information on what can be done but also asks the patient about his or her preferences about how to live and how to die.  He argues that the family needs to be brought into this collaboration as well, both to become informed about the patient's wishes and to ensure that the doctor does not make all the decisions. 

The last part of Being Mortal deals with the death of Gawande's own terminally ill father, a surgeon himself (his mother is also a doctor) who eventually opts for hospice care.  By writing about his own family's experiences, he illuminates a better way of dealing with the limited time left to an individual and how this process in turn can help the family cope with that death when it comes.  Described this way, it may sound barren, even cold.  It is not.  Rather, it is a moving account that makes the reader empathize with the entire family. 

This is a heart-warming book, humane in the best sense of the word.  Atul Gawande's Being Mortal:  Medicine and What Matters in the End deserves to be read by every adult in this country:  it is that good and that important. 

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