Book Review: Being Mortal by Atul Gawande

Last week, my beloved sister in law (Charro) sent me a surprise gift, a book, Being Mortal by Atul Gawande. Charro is from Palo Alto, CA and is a nurse oncologist. She works at Stanford University Hospital doing cancer research.

I read the cover page of the book and it sounds very interesting being a senior citizen. However, when I opened the first chapter, the font of the book is small, I could hardly read it. So I did an Internet search and here's an excerpt from the review of SHERI FINK dated NOV. 6, 2014, published in the New York Times. I recommend this book to all senior citizens of the world. Thanks again for your gift, Charro.

"It began with a tingle in the surgeon’s fingers and a pain in his neck. A couple of years later, he learned he had a tumor inside his spinal cord. That was when the difficult choices began. Should he have it removed right away in a risky operation, as his doctor recommended? Or should he take time to consider this question: At what point would the expanding tumor cause debility bad enough to justify the risk of greater debility or even death in trying to fight it?

The surgeon in the story is the father of Atul Gawande, who is also a surgeon as well as a writer for The New Yorker. His new book, “Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death.

Medical professionals are the ones who are largely in control of how we spend our “waning days,” he writes, yet they are focused on disease, not on living. “Medicine has been slow to confront the very ­changes that it has been responsible for — or to apply the knowledge we have about how to make old age better.” The experts quoted here argue that doctors should not only treat disease but also concern themselves with people’s functional abilities, and that most medical trainees should learn about geriatrics.

In the first part of the book, Gawande explores different models of senior living — from multigenerational households to newfangled nursing homes. In the latter part, which is shorter, he shifts somewhat abruptly to end-of-life medicine, promoting hospice as a model of care. The two sections are anchored by two of Gawan­de’s most memorable New Yorker essays, which make up two of the book’s eight chapters — “Things Fall Apart” and “Letting Go.” Around them are rich stories from his own family.

“Being Mortal” is a valuable contribution to the growing literature on aging, death and dying. It contains unsparing descriptions of bodily aging and the way it often takes us by surprise. Gawande is a gifted storyteller, and there are some stirring, even tear-inducing passages here. The writing can be evocative. In a home for the aged in a New Delhi slum, mattresses are “pushed up against one another like a large sheet of postage stamps.”

The stories give a dignified voice to older people in the process of losing their independence. We see the world from their perspective, not just those of their physicians and worried family members.

One of his most provocative arguments is that hard-won health and safety reporting requirements for elder care facilities might satisfy family members, but ignore what really matters to the residents in question. Despite the popularity of the term assisted living, “we have no good metrics for a place’s success in assisting people to live,” Gawande argues. A life of safety isn’t the life most people really want for themselves.

Gawande searches for models of care that promote frail people’s ability to live a meaningful life, by imbuing them with cause or promoting their ability “to keep shaping the story of their life in the world.” The reader may wonder if everyone in these innovative senior communities is as satisfied as the individuals Gawande profiles. Given that there is little data to back up the anecdotes, it’s hard to know if there are real solutions here. There is also relatively little exploration of the options for people with dementia.

In the last part of the book, Gawande argues against the treatment-at-all-costs model that once prevailed in medicine. “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.”

Gawande is swayed by the paleontologist Stephen Jay Gould’s essay “The Median Isn’t the Message.” After receiving a cancer diagnosis with a median survival of only eight months, Gould observed that some patients survived well beyond the eight month median. He became one of them, living some 20 years after experimental treatment, and dying from an unrelated cancer.

Gawande uses his father’s powerful story to explore the concept of shared ­decision-making in medicine — the idea that the ideal modern doctor should be neither paternalistic nor informative but rather interpretive, helping patients determine their priorities and achieve them. He shares lessons he learned from a palliative care doctor who advises him to “ask, tell, ask” during a difficult discussion about a patient’s prognosis: Ask what patients want to hear, tell them and then ask what they understand.

Gawande identifies no perfect solutions to the problems inherent in bodily decline. He is just asking us to commit ourselves to creating better options and making choices with the goal of a purposeful life in mind ".

About the Author: Atul Gawande has been a staff writer for The New Yorker since 1998. He is the author of three best-selling books: “Complications,” a finalist for the National Book Award; “Better,” selected by Amazon.com as one of the ten best books of 2007; and “The Checklist Manifesto.” His latest book is “Being Mortal: Medicine and What Matters in the End.” He has won the Lewis Thomas Prize for Writing about Science, a MacArthur fellowship, and two National Magazine Awards. He is also a surgeon at Brigham and Women’s Hospital, in Boston, and a professor in the department of health policy and management at Harvard School of Public Health and in the department of surgery at Harvard Medical School. He is the executive director of Ariadne Labs, a joint center for health-systems innovation, and the chairman of Lifebox, a nonprofit organization making surgery safer globally.

Personal Note: Last week I cancelled an elective surgery-Kidney stones removal( lithotripsy) scheduled for next month. After talking to my urologist, I decided that the risk of surgery will be worse that the benefits I will receive from the surgery since currently I am feeling well and the stones are not giving me any problem. The surgery does not guarantee all the stones will all be removed and the post surgery may even cause serious pains due to a uretheral stent that may be used. So far as for now no surgery. Hopefully I will not have any kidneys stones attack in the future.