Being Mortal: Medicine and What Matters in the End

This is a really beautiful, sorrowful book. I have lost both of my parents and so much of what is described here takes me back to those moments. The pleading of my dad that he never be put in a home. The exhaustion of taking care of my mother during her cancer. The despair of dealing with doctors who withheld information because they felt they knew best. Not knowing what the next day would bring. That was always the hardest thing. You never know, you simply endure. I'd recommend this to people with aging parents or people interested in medical nonfiction.

In a way, this is a brutally tough read. But that's because Gawande does an excellent job of making you comprehend the helpless sense of imprisonment that besets the elderly and terminally ill.

The concept of the patient's conditions for treatment, “I want to be able to watch football and eat chocolate ice cream,” is a profoundly simple but effective way to diminish the burden on your loved ones. There's so much in this book along these lines and while the subject matter is grim, it fills a massive void in end of life wisdom that I doubt many of us would otherwise encounter until it's too late for our loved ones.

It took me over a year to get through it because I kept putting it down, because it's a difficult subject. But, that's the point. EVERYBODY SHOULD READ THIS.

If you love someone who is going to die, or if you yourself are going to die, you should read this. It's so important. Just read it. Stop avoiding it. You'll be glad you did.

I heard about this years ago through an interview Gawande did on The Daily Show (http://www.cc.com/video-clips/hz2xb6/the-daily-show-with-jon-stewart-atul-gawande). Having finally gotten to this, I wish I'd read it sooner. I listened to this from the library but I feel like I need to go buy a copy for myself and give copies to everyone. We do so much wrong medically in this country, elder and death care being just a part of it, but that part is so important. Out of the three grandparents I've lost, and the two I really remember, one had a lengthy decline that I don't think anyone would want to replicate. Even as a twelve year old I knew it wasn't right, even if he was at home. I wonder what he would have preferred in those last days, months. Now, with my last grandparent getting older and having more problems, I want to give this book to my mom and uncle and see what we can do for her. We can do so much better in this country and Gawande lays out some very basic ways of going about it.

Wow. I am not certain what brought me to read this book, but it has a powerful message about planning ahead for a dignified end of life. Ultimately, the author compels the reader through narrative stories to think through what they want to do and what tradeoffs they are willing to take when they begin facing serious impairment to continuing basic care.
Since everyone will die at some point, I think everyone should read this book or at least take a few moments to research palliative care and plan for the eventuality. This is not planning for after the end of our days (burial, cremation, etc.) but for planning for our last days (years) before the end.

A remarkable book that cannot help but shape and form you and the rest of your life. It is honest, vulnerable, gracious, and wise. It will also shake you and bring out fear and pain while forcing you to face and think about the hardest parts of human existence. This book will not leave me for the rest of my life, and I am glad for that.

I started reading Being Mortal nearly a year ago and somehow never got around to finishing it. It's admittedly a difficult read in the sense that it can be overwhelming at times. I finally finished it last night.

The premise focuses on the quality of life rather than the length of life and more specifically, the manner in which you choose to pass away. Medical science has advanced to such a degree that humans can be kept alive for a much longer time than you would imagine. But no one has stopped to ask the question of whether we should. Or as in Amitabh's immortal (no pun intended) words, yeh jeena bhi koi jeena hai. Gawande cites several examples from his professional and personal life that focuses on the individual's choice on care and ultimately, way to die. The Republicans' favorite chant ‘death panels' actually referred to the end of life counseling that doctors offered their patients. It's the ultimate decision you can take for your life.

You do not choose to be born in this world and as of today, most laws even prevent you from actively choosing to die but at least you can choose the way you die when and only when you're diagnosed to. The DNR is the most commonly known legal process in our pop culture and medical professionals are taught to honor it just as they're taught to honor the first do no harm principle. Others like hospice care are fraught with emotions that you may not be fighting back hard enough. But after a while, it's useless fighting nature.

Being Mortal will not only make you aware of your mortality but actually prepare you for it. I say that in the most humble and optimistic way. You aren't immortal. You're going to die. You're born in perhaps one or two ways but you can die in umpteen different and uncharacteristic ways. The worst I believe, waiting to die which can be a long and painful process not only for the person but also for their loved ones. Modern medicine can perhaps keep you alive for as long as it is possible today but it's entirely within your rights and choice to decide when enough is enough.

In essence, the idea is to make sure you kick the bucket at the right time, otherwise you have a high risk of getting the ODTAA syndrome (One Damn Thing After Another), some your friends and family members will die before you do, your frail body starts failing in ways you would've never imagined, you have to make tradeoffs that will be hard to endure and sooner or later you will become a burden to your close ones (given you have any) or get sent off to a nursing home where death lingers at every corner. The book is actually about more than that, but this is the most important conclusion I can draw from it at this point.

Even if you think you're up on end-of-life issues (ethics, logistics, medical questions), or even if you're young-and-healthy and don't think this matters to you ... there's something in here for you to learn.

First, it's Gawande. I always learn from Gawande and always enjoy myself in the process. I bet you do too.

Second, there is important new material here. On perspective, on the history and current best practices in assisted-living facilities, on geriatric research and the sad dearth thereof. Even if you or I don't need this material right now, we can be better informed and speak to policymakers when opportunities arise.

Finally, there is a delicate personal component to this book, Gawande's story and others', which I found powerful and humbling. I think we WEIRDs could learn much from looking at aging instead of averting our eyes, and this book offers a gentle way to start doing so.

This book was amazing. It accomplished something that very few books can: to change my mindset in a complete 180. In my life I haven't truly had the need to engage with older people on a daily basis, but I know that's going to invariably change, and I feel like this book kind of prepared me for those coming times.

It gave me a new outlook on the importance of taking care of our elders, provided me with facts that show just how little we tend to them and how big of a taboo it is in our current societies.
Super important read that I would recommend to anyone over the age of 20.

It's coming for us all. We choose to ignore it, forget about it, laugh it off, distract ourselves. But, nevertheless, we are all headed for those last days of our lives. (Some of us probably aren't even going to have half as many days as we think we will.)

Gawande bravely takes on aging and death and shares personal experiences and reflections on best practices for physicians and families and individuals who find themselves eye-to-eye with aging and death. I say amen and thank you, brother. A much-needed little book.

Like other books of Mr Gawande, this gives a nuanced and balanced narrative by focusing on particularities in last few months of life for terminal patients. This is a reality most of us would face sooner or later, either for loved ones or ourselves, being prepared for it and taking more parameters into account, rather than just focusing on prolonging life, would result in better outcomes both for the patient and the family.

This book is an absolute must read for everyone in our society. Any society. I cannot recommend it highly enough, because it is IMPORTANT. The topic is important, the discussion is important and most of all, it is important that YOU begin thinking about these things for you and your parents. As in right now.

Atul Gawande's Being Mortal explores the impact of aging on our bodies, our life experiences, our family dynamics, our societal structures, and our healthcare system. We as individuals rarely take time to think about our own future as we age and become more feeble and start having falls. What about our parents? What do you think about nursing homes? Is there a better option? Honestly, Being Mortal doesn't exactly give us discrete answers. But it's a very complicated problem and the first step towards getting better options and eventually a better answer is to start putting some thought into the situation. That is especially true for each of our individual families.

Short Review of Being Mortal: Medicine and What Matters in the End by Atul Gawande - a look at what our system of care for the terminally sick and elderly can and can't do and how we can improve things. The first section is about history of our system of housing and care (nursing, assisted living, hospice) does a good job of showing how institutional responses are efficient and make sense economically, but are inherently dehumanizing and removed dignity from the end of life even more than the loss of capacity does. The second main section is about doctors and treatment and how there is a reluctance by doctors to not always communicate hope and so patients usually end up thinking that their options are better than they really are and there is not enough conversation about what a good life means (and often the treatment to extend life removes options for living what the person would consider ‘a good life'.)

The next to the last chapter, on how to have end of life conversations, is worth the price of the book. While I think this whole book should be required reading for pastoral care classes, this chapter is essential reading for pastors.

Throughout Gawande weaves in his own personal stories, about his grandfather in India that lived until he was 110, and his wife's grandmother who went through the traditional American system ,and his own father, as well as many stories of patients and others that he has met. These stories humanize the discussion and keep this important subject from being dry.

Two big takeaways for me. 1) Research indicated that most patients looking at major treatment for cancer expected that the treatment would give them 10 to 15 years of life. Most doctors expected that the same treatment would give 1 to 3 years of life. There is a real disconnect between patient and doctor expectations. 2) Gawande's father, mother and himself are all doctors. They were trying to evaluate treatment options for his father's cancer and have well over 100 years of medical experience between then and still they felt like they didn't really know enough to make a good decision.

I finished the book and immediately asked my parents and mother in law to read it. They are all in good health and relatively young, but I think the clear message of the book is that you need to have discussions and process things before they are needed. A book I highly recommend.


Click through or the full review on my blog at http://bookwi.se/being-mortal/

How we make end of life decisions is still hampered by our need to have answers, to prolong life. Doctors offer us information, explaining what the red pill does vs the blue pill. In a telling moment, Atul Gawande along with his mother is listening to the attending doctor explain possible treatment options for his ailing father. All three Gawande's are doctors themselves but found the options confusing and difficult to parse.

Outlining treatment options isn't as important as considering how we want to end our lives. What comes through in the book is that, for terminal patients, the cure is often worse than the disease. That prolonging life comes at the cost of the quality of that time.

Gawande also spends time on elder care facilities and their need to better cater to the lives being lived there. Autonomy, privacy and possessions trump schedules, spartan arrangements and concessions made in the name of safety.

Gawande is a warm writer with a wonderful bedside manner. I've already gifted this book to my folks, even though they've got years to go, to better discuss what's important to them as they age.

Reading this book helped me understand my mother-in-law's reluctance to move into independent living, helped me realize that what we as children want for our parents (safety, health) is not necessarily the most important for them (to have control of their own story/life), to value the first assisted living concepts and what people are doing to try to provide a place for the elderly that has life and autonomy and isn't designed for those who work there and the medical industry. To understand that whether it's because your old or because you've been diagnosed with a terminal illness, your perception about life often changes and you start to be instead of achieve, to value time with family more than new adventures, and to understand the value of hospice and the difficult choices we all face as we or our loved ones are forced to deal with end-of-life decisions. I learned, I cried, I loved this book.