B O O K
R E V I E W
Being Mortal by Atul Gawande
and writer whose family originated in
India. His elderly grandfather at over
90 years old, lived with his sons and
still “managed” the family lands. He
practices surgery in Boston, from this
experience he saw that in America
it is common for the elderly to enter
residential care as the families are
either unable or unwilling to provide the
necessary care. He is therefore well
placed, with a foot in two seemingly
very different cultures to examine,
what is, effectively society’s attitudes
to life, death, aging and pretty much
everything in between.
Unless you are an avid Radio
4 listener, or devotee of the
American-surgeons-turnedauthors sub genre you
may not have heard of Atul
Gawande. But you should.
His book “Being Mortal” is
one of the most wonderful
books I have ever read, and
I’ve read a lot of books. This
book should be on the school
curriculum, given out at train
stations, and compulsory
reading for anyone who
comes into contact with
people on a daily basis.
Why is it so good? Because it talks
about philosophy, medicine, cancer,
death, community, control and society
in a deeply personal fashion, but with
universal application. It starts as an
investigation into the limitations on
the author’s medical training when
confronted with terminally ill patients,
and expands into how society works.
It’s written beautifully, and clearly.
Atul Gawande is an American surgeon
22
If all that hasn’t put you off, I should
probably tell you a bit about the book.
Through a series of pen illustrations of
some of his patients interwoven with
his own experience of an aging parent
he examines what is fundamentally
important to people, and how our
perspective can impact on that. And
perhaps even more helpfully, he offers
a suggestion of how to help people
achieve this.
Gawande tells stories of his patients,
and of his family, switching between
the two with ease. The patient story
that most sticks in my mind centres
on a terminally ill cancer patient. He is
asked to operate on her. That’s what
he is trained to do. But the question
is “should he?”. He discovers that he
is totally ill equipped to really TALK
to the patient about her situation.
He’s a trained surgeon. So that is
what he does. Surgery. The surgery
goes well, but inevitably, the patient
dies, and he ponders whether she
could have had a better death. This
forces him to consider whether the
medical profession in fact failed her by
operating, instead of really talking to her
about her situation, and what she really
wanted. Was it cowardice, or lack of
training on his part, not to discuss the
fact that his patient was dying?
His experiences lead him to talk with
nurses, geriatricians and, importantly,
people in the hospice movement.
Practitioners here are trained to
really talk to the dying. They are not
squeamish about discussing dying, and
see it as vitally important to help their
patients best prepare for death. He
finds that those who fully understand
and engage in their own care tend
to live better for longer, before a less
medicalised death.
Whilst building his practice, writing
books, and having his own family,
Gawande is also coming to terms with
the fact that his father, a formidable
man, is not only aging but dying
slowly. He examines the many options
available to the elderly, from full
independence, through sheltered living,
to full residential care. Along the way
he meets some wonderful characters
from pioneers of the assisted living
movement who were just frustrated
with the options available to them to
feisty pensioners setting up a mutual
fund to pay for handymen (and women)
to help keep them in their homes. He
also visits a residential care home
complete with pets for the residents.
Unsurprisingly he finds that those who
have to care for another living creature,
even a plant, are more engaged and
busy getting on with living, than waiting
to die.
So what are his conclusions? Well
without any spoilers, it’s not rocket
science. The key is communication.
And control.
When we’re young and in our prime,
control means setting our own destiny
and future planning: a family, a home,
a career, retirement. The horizon is
distant, so it’s easy to put up with some
discomfort for a future goal. But as
the horizon gets nearer, the goals get
smaller, but no less important. Control
for a dying patient may be as simple as
eating at a time to suit them, not
the carer.
This book really made me think.
Gawande shows that professionals,
care givers and doctors, but by
extension all of us need to have the
hard conversations, but that the
rewards of doing so are enormous.
When we know what’s important dying,
but also living, is much easier, and
joyful. It shouldn’t be called “Being
Mortal”, it s hould be “Being Human”.
Read it now.
By Fiona Dodd