One thing in life is certain: We will all die. Despite this certainty, we push this frightening fact out of our minds. With the help of technological advances in medicine and scientific discoveries, humans are living longer than ever. Yet, how we want to live our last days or where we want to be when we pass is seldom discussed; even as medical providers speaking to their patients.
Being Mortal: Medicine and What Matters in the End by Dr. Atul Gawande addresses how our mortality has been handled throughout history and the medical advancements we have today. Dr. Gawande explains the recent shifts in taking care of the elderly from being in multi-generational households to nursing homes and now, assisted living centers. Being Mortal reminds us that although our bodies begin to deteriorate over time, our need for independence and self-purpose continues to reign supreme. It also explains that near the end of our lives, whether due to age or a terminal illness, our needs and perspectives shift. We ask ourselves, “what truly matters to me?”, yet we are often wildly unprepared to answer that question.
Dr. Gawande also discusses the important role healthcare professionals play in end-of-life conversations and decisions. He writes, “The simple view is that medicine exists to fight death and diseases, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.”
Doctors are often overly optimistic. They do not want their patients to die. Some take a paternalistic, know-it-all approach while others are only informative, offering different options and letting the patient decide on their own. Being Mortal pushes us to recognize that we need doctors who are willing to have difficult conversations about what matters to individuals in the end. We need a shared decision-making approach that is best for patients and their loved ones.
Dr. Gawande offers a multitude of stories that resonate with the reader, like the story of his own father’s death and bout with illness. He also discusses the story of a caring geriatrician, who eventually retires and has to face old-age like his patients, and a young pregnant mother affected by terminal cancer. His stories bring up the fight in medicine between life-prolonging medical advancements and the human desire to have a “good death.” Dr. Gawande's meaningful research and emotional storytelling leave an impression on the reader as both a recipient of being mortal and as someone in medicine who strives to care for patients who will ultimately face death.