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January 2019: Being Mortal (Gawande)

posted Feb 7, 2019, 10:12 PM by East Bay Smith Club

I don’t know if it was the effect of all our New Year’s resolutions or if the topic of mortality is just a good seller, but we had a stupendous turn out at our January meeting.  Eighteen members showed up, and I was impressed that Betsy, our host, found enough chairs to seat us all comfortably in her living room!  


Our topic was Atul Gawande’s Being Mortal:  Medicine and What Matters in the End.  Gawande is a practicing surgeon, a public health researcher and advocate, and a popular author.  In this book, he explores the ways that Western societies have “medicalized” the realities of aging, frailty and death.   Although driven by understandable and admirable desires to care for an ever increasing population of elderly adults, the priorities of our medical interventions often fail to address the needs and values of the individuals involved, frequently causing genuine harm to peoples’ mental and physical health.  For example, Gawande charts the development of nursing home care over the past one hundred years.   Prior to this time, most seniors were cared for at home or in poor houses or other similar institutions.  Our changing society and economy has made the first option less and less viable, and no one is advocating for a return to the latter.  However, the development of nursing homes has not been without growing pains.  They have had to change and evolve in order to accommodate the needs of their residents.  For example, a focus on patient safety and ease of care, created situations that compromised patients’ sense of autonomy and purpose, driving some to the point of despair.  The changes in care home design and organization that address these problems may seem quite obvious now, but they took some pretty creative leaps on the part of health care innovators, who had to work tirelessly to change the system.    Gawande describes these efforts and discusses issues that have not yet been addressed.


Gawande also explores other aspects of human mortality, such as the creation of advanced directives and other decisions about whether particular health interventions are worthwhile.  As well as discussing such matters in the abstract, he gives numerous examples of the personal journeys of patients that he treated or knew.   In the end, he explores his own struggles with his father’s final illness.  These examples help to give emotional salience to the historical material and statistical information Gawande provides.  The result is a compelling call to action.  No matter how uncomfortable the topic, we need to have hard conversations with ourselves, our loved ones, and our society about how we can address the needs of the elderly, the frail, and the terminally ill without sacrificing the things that make our lives worth living.


The book gave our group plenty to think about, and our discussion was lively and, at times, quite emotional, especially when members shared personal recollections of the illnesses and deaths of loved ones.  We were also really fortunate to have a couple of members who provide palliative care professionally and who were able to give us detailed information about how some of these end of life decisions are negotiated.   There were not too many comments on the structure of the book or on its writing style, though most approved of the use of stories to clarify the facts and figures.  In fact, many of the specific points in the book that we recalled most vividly were contained in these personal stories.   We also saluted  Gawande’s decision to discuss his own family’s experiences.  Some commented on the humility evident in his account of his own thought processes.  Despite all his professional knowledge and his theoretical understanding of human mortality, he still found himself struggling to come to terms with the his father’s final illness and to separate his own desires as a son from his father’s wishes as a man facing his own death.    I guess Gawande’s difficulties at that moment are a powerful illustration of one of the themes of the book.  Death reveals, perhaps all too clearly, the fact that we are only human.  The challenge is to retain and respect our humanity as fully as possible until the end.