The Challenge of Being Mortal

Being Mortal: Medicine and What Matters in the End, by Atul Gawande is a book about how people might live successfully all the way to their very end. Gawande is a practicing surgeon with a gift for putting medical challenges into language that the general public can easily understand. My response to the book’s goal was, “Oh my! Yes! Tell me more!” And he did. He gives us a little US history to put things in perspective.

Stage 1- The country was in extreme poverty, deaths occurred in the home because people did not have access to professional diagnosis and treatment.
Stage 2- US income levels increased. With greater resources for medical care, people turned to health care systems when ill, often died in the hospital instead of at home.
Stage 3- US income climbs to highest levels, people have the means to become concerned about quality of life, even in sickness, and deaths at home rise again.

Gawande takes us through a variety of existing assisted living situations with private living spaces that boast live plants, gardens, animals, birds, visiting children, and a variety of classes and activities. They are more like homes than the double occupancy nursing homes we know. Some have pod arrangements with private rooms for residents surrounding common kitchen and living areas. One includes an auditorium where concerts and lectures draw in the surrounding community as well as residents.

As more assistance is needed, Gawande takes us through several actual scenarios that underscore the need to clearly spell out what is important to us. Gawande leads us gently through palliative care conversations that make satisfying decisions about surgery and other treatment possible, what level of being alive is tolerable, what is most important. One person might be willing to go through a lot of pain to be able to eat all the chocolate ice cream he wants and to watch unlimited football on TV as long as possible. Another may not choose to prolong life if she can no longer be an active participant with others.

Gawande takes us through the way to have palliative care conversations that make dying a successful experience. We meet Hospice, the service that aims to make each day the best possible by managing pain and other symptoms and providing assistance as needed for a manageable steady state.

What could be a morbid book instead opens up the strength of persistence in managing our exit. We are still smoothing out the tangles of US history’s Stage 3. For their own families, even doctors must deal with the same hurdles in our medical/cultural system. Gawande has certainly cleared the road less taken for us.

Being Mortal is available in local libraries and through Inter Library Loan.

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