Tuesday, June 28, 2016

Being Mortal

Benjamin Franklin astutely said "In this world nothing can be said to be certain, except death and taxes." Thankfully modern science has altered the course of human life, helping us all to live longer, delaying the inevitable. In Being Mortal: Medicine and What Matters in the End by Atul Gawande, the surgeon and author asserts “We’ve been wrong about what our job is in medicine…We think it is to ensure health and survival. But really it is to enable well-being. And well-being is about the reasons one wishes to be alive.” Being Mortal is a book about the experience of mortality in today's society. Relying on anecdotal evidence from doctors, patients, health care providers and families, as well as his own personal experience with the death of his father, Gawande highlights how people experience the end of their lives – from the elderly in nursing homes forced to give up their privacy and autonomy, to seriously ill patients who face their waning days living through painful treatments that drain both their body and soul.

In Being Mortal’s critique of the nursing home system, which comprises the largest part of the book, Gawande examines how the old have to yield all control over their lives in accepting the rigidity of nursing home life; ceding their privacy in shared rooms and all control thanks to set schedules for every activity and hour of their day. While the official aim of an institution is caring and safety, for many of its residents it isn't always what some would call living. Gawande asserts that there are possibly better approaches out there today, and offers compelling success stories of caring innovators that have come up with groundbreaking solutions by thinking outside the box. One such example is a retirement community in the Boston suburbs called NewBridge. While still a nursing home, it’s so different from what we’ve come to expect; instead of housing 60 people to a floor in shared rooms along hospital corridors, NewBridge is divided into smaller pods with no more than 16 people. Each pod is called a household. Rooms are private and built around a common living area with dining room, kitchen and activity room like a home; namely, like the homes many elderly have been forced to give up.

The latter part of the book focuses on terminal patients, end of life care, and how many times medicine fails those it is supposed to help. Gawande discusses how many times doctors, including himself, and patients avoid talking honestly about the choices faced by ill patients near the end. While there is always something more which can be done, the question doctors and patients avoid is whether it should be done. “People with serious illness have priorities besides simply prolonging their lives,” he writes. “If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity and extraordinary suffering.” Though Gawande doesn’t offer easy answers on this subject, his wholehearted advocacy of hospice care is readily apparent. In speaking of his own father’s experience with hospice care he states “Here is what a different kind of care — a different kind of medicine — makes possible.”

Being Mortal is a fascinating and eye-opening read. A book that compassionately sheds a light on truths that realistically will impact us all one day, whether directly or indirectly. More importantly it offers a lesson in empathy, for every story shared comes with a name that is or was a living, breathing human being that was sad, lonely, sick, or scared and fighting for their due respect from life and those around them.