Being Mortal: Medicine and What Matters in the End by Atul Gawande.
Metropolitan Books, Henry Holt & Co, New York, 2014.
Nonfiction, 282 pages.
Because his parents both immigrated to America from India, Gawande didn’t have much first-hand experience with aging or mortality – the elderly members of his family were a continent away, being cared for by others. He certainly didn’t learn much about it from his medical school classes. Then he came face-to-face with the reality of American aging through his grandmother-in-law and patients, and decided to raise some questions about end of life-care and the meaning of life, and death.
Gawande has an interesting perspective on mortality and his second-generation-immigrant perspective gave him an insight into other methods of dealing with age that helped him turn a critical eye on how we deal with it here in America. This book reminded me of Another Day in the Death of America in that way – it takes a subject that most Americans wouldn’t even think twice about, and presents it to everyday readers.
Where average gerontologists (whom Gawande consults during the book and has a great respect for) might have written a book for medical professionals or the elderly, Gawande takes a broader view and has written a book for everybody. He feels that this problem relates to everybody, because we will all grow old and eventually die. And every human desires and deserves a meaningful life with the ability to make some choices for themselves.
Woven throughout the book are two types of personal stories. Some are those of patients or other people he met. The other stories, which often continue over several chapters, are those of Gawande’s own family, from his grandfather in India to his own parents.
Gawande has a talent for weaving these deeply personal stories and memorable anecdotes amidst medical facts, conversations on different aspects of mortality, and more standard journalistic reporting. This book is definitely not for the squeamish as there are descriptions of medical procedures, deaths both poor and well done, and explanations of the physical changes of aging that are uncomfortable to read at times.
However the stories keep a reader engaged. It’s not much of a spoiler to say that in this book on mortality, most everyone dies eventually. But as we read, our criteria for a happy ending change, gradually led by Gawande’s insightful commentary. Now we are watching to see whether someone has a good death or not. Is their end full of misery, clinging to life through repeated invasive procedures granting empty hours? Or are they dying peacefully, content with the life they’ve lived?
Gawande also develops the history of the nursing home, hospice care, and other developments in the understanding of aging and mortality in the United States. He shows not only how far we’ve come, but also how much further we could go with just a few extra steps and a change in attitude.
There are a few implications here that Gawande, reasonably given the scope of the book, does not pursue. If the general feeling in America is that loss of physical independence is also a loss of a worthwhile life, then that has implications for people who are physically disabled regardless of their age. Gawande touches on mental illness and depression at a few points, but it mostly comes up as elderly persons are affected by situational depression when their independence is removed and they are institutionalized.
There are also some remarks about the unsuitability of housing the elderly with mentally ill people. They were mostly from a historical perspective but I felt Gawande might also have some discomfort with mental illness. That was my only real sticking point on this book.
While the book as a whole is not religious, there are a few references to different religious views on the end of life. And the epilogue, which was quite moving, focuses on Gawande participating in a Hindu funeral on the Ganges.
While this is an adult book (and as always, I do recommend pre-reading), a thoughtful teen or even an advanced and not overly sensitive pre-teen could gain a lot from reading it. I’m not sure that many young people would be interested in the topic though!
My review on this book is probably not needed. It’s a bestseller and has many critical reviews. However, for what it’s worth, I’d generally recommend this to adult readers of any age.