Being Mortal: Medicine and What Matters in the End

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/