Being Mortal: Medicine and What Matters in the End

The importance of this book is profound. He is saying what many have said before but he has a larger audience and a prestigious career. It is not unlike what a Harvard spokesperson, Dr. Jon Kabat Zinn has done for mindfulness meditation and the mind/body connection. The book explains the research studies in clear language, easily understood by the general public. This is not easy to do in science writing. he is a good storyteller and unlike some readers, I did not find the stories repetitive. The most critical review talks about what do we do instead of nursing homes, especially with elders who have no one who who wants to make the sacrifices of being the caregiver. It will be up to us boomers to start developing more Sanford apartments, Villages and Green homes in our own areas so that we can have more choices. If we leave it up to the investors and the medical system we will get more of the same, high cost assisted living for the affluent that emphasizes never getting sued over quality of life for the elder. Nursing homes emphasize routines that lead to "no falling" because that is a factor emphasized and financially rewarded by the institutional system. We will have to take charge of developing the alternatives.I have watched both my parents die in nursing homes and had to advocate for my parents against the "rules." In Georgia, I had to contact the ombudsperson assigned to my mother's nursing home so that her private caregivers would be allowed to move her to her bedside commode when she needed it, not when the staff had time. These are the unfriendly traditions that you do not even know you can do something about until you research it. I particularly think that the value of this book could be that it encourages families to have the hard conversations. Every family facing the physical decline of a loved one who will soon no longer be independent should read the book together and follow the guide for the conversations about "what matters most to you and what are you willing to trade off to get that? .. I liked his writing style, his humility about the confused role medicine plays, his alarm about the decline in the field of geriatric medicine and his practical approach and attempts to do better with patients. An honest and refreshing appraisal of the systems that will take over for us if we do not make a different plan.

If you are the child of an aging parent, read this. If you are a person of a “certain age”, read this. If you are in the medical field, read this. If you hate hospitals, read this. If you want a thought provoking, sobering read - one that is wise and helps you reframe a lot of hard things in life, read this. If you are reading this, read this.

This is probably the most important book on mortality I've ever read. It is packed full of information and written in easily comprehendible language, in fact, very personal language. There is so much information here I had a hard time reviewing as I want to share it all! Promise, I won't, but will try to stay with just a few important highlights. First, this book looks at nursing homes and the rise and fall of assisted living. You may think, what? We have assisted living. But, for a short time after people no longer simply died at home, assisted living, through the hard fought battles of one woman in particular was available to all patients. Now the primary goal of safety has once again given us nursing homes. Assisted living is mostly for those with the money to afford it. This need for safety has left many to languish at places no different than former asylums. This so called "life" is devoid of any purpose to live, and actually increases death rates. This book then goes into the medical profession. The focus here is on repair, how to fix, what medications will work, when is surgery necessary. The only problem is that the medical profession has no idea how to talk to people, and is even discouraged from doing so. Most doctors have not had a single course in geriatrics. What to do with an old person? Amazing that we have no sense of our own mortality. Now 25% of Medicare spending is for 5% in their final year of life, with very little benefit. A great quote was "We imagine that we can wait until doctors tell us there is nothing more they can do, but rarely is there nothing more that doctors can do." So this instance of survival at all costs has left many to die in a hospital with tubes everywhere, fading in and out of awareness. This of course leaves no chance for good-byes, even "I'm sorry" or "I love you." What it really comes down to is a few important questions. I loved the ones provided in this book. "The biggest questions to ask are, what are your biggest fears or concerns? What goals are most important to you and what trade-offs are you willing to make, or not make?" Another topic was hospice. I assumed hospice is only for the final end of life, but it is not. Hospice is available at any time, and the focus is on a person's wants and needs. Many get better after a stay, and leave, some even return to work! Incredible book. Atul Gawande is a physician who I believe has written a most timely and important book. He provides an inside look at medicine, a historical perspective on dying, the most recent surveys on cost and care options and so much more. He comes from his own experiences and clearly his research has changed his own outlook on mortality. A must read. Highly recommended!

Such a brilliant book written with such compassion and deep understanding.

El tema es muy importante para todos. Nos ayuda a ver con nuevos ojos cómo enfrentamos las enfermedades y la vejez.

Es un libro que está escrito desde un punto de vista muy humano, a la vez que realista, estos dos factores, unidos a una prosa sencilla y clara hacen del libro un antídoto contra el miedo a la muerte, al menos es el sentimiento que produjo en mí que ya tengo 85 años.

Wer sich - aus welchen Gründen auch immer - konkret mit Gebrechlichkeit, Alter, schwerer Krankheit oder Sterblichkeit auseinandersetzen muss, ist sehr gut beraten dieses Buch zu lesen: Der Autor ist kompetent, erfahren, reflektiert und schreibt einleuchtend, eindringlich und einfühlsam sowohl über die Mängel und die Ignoranz im professionellen Umgang mit dem Nahen des Todes als auch - an eigenem familiären Beispiel - über unsere unausgebildeten Emotionen und unsere Hilflosigkeit als Betroffene. Kurz: "Being Mortal" ist auf höchstem Niveau emphatisch, bewegend und informativ zugleich.

This book addresses the inescapable fact called death, how we can face this with dignity, how medical profession can help us in this regard.The author is a surgeon at Brigham and Women’s Hospital in Boston. He is also a successful writer on popular medicine. The book opens with an interesting statistic. In USA, till 1945, most deaths occurred at home. By the 1980s just 17% did. The rest died in hospitals. What is the reason behind this rather expensive ending? The answer ironically is the progress made in medical care. The author gives a scary description of ageing process. Teeth decay is most common. Jaw muscles lose about 40% of their mass and bones of the mandible lose about 20%. Ability to chew therefore declines. While our bones and teeth soften, rest of the body hardens. Blood vessels, joints, muscle and valves of the heart pick up substantial amounts of calcium and turn stiff. Since heart has to exert more to pump blood to these stiffened arteries, we all develop hyper tension. Lung capacity decreases. Even our brain shrinks and actually rattles inside making us vulnerable to cerebral bleeding even with minor head injuries. Eventually death becomes a question of when? Not If. Doctors are trained to keep patients alive as long as possible. They are never taught how to prepare people to die. They therefore subject you to all kinds of therapies and surgeries and prolong life. Should medical profession rethink its approach? Yes! Medical profession at least in developed countries have realized that longevity should be replaced with making life worth living even if it means shortening it. The author now gives various developments taking place and their shortcomings. Geriatrics specializes in Medicare for aged. Unfortunately this is not a glamorous branch like plastic surgery. Consequently doctors and institutions specializing in geriatrics are few in number. What can be a better option than a nursing home for the aged and debilitated? Comfortable bed, nursing care, timely medications, doctor on call and above all not being a burden on the children. On the face of it a nursing home appears ideal and several have come up to suit all budgets. The reality however is different. Old people hate nursing homes. The author explains why? Nursing home is two words. Not one. Besides nursing, it has to be home as well. Prisons, orphanages, mental hospitals and military barracks have striking similarities with nursing homes. It is a regimented life denying adults the much needed autonomy and self respect. Assisted living is a radical improvement over nursing homes. Inmates enjoy better autonomy. The group living concept helps in overcoming monotony. Management allows inmates to take certain risks. The underlying philosophy is happiness of the inmates rather than keeping them alive at any cost. Hospice is an institution that takes care of chronically or terminally ill. There are also hospices at home facilities. In USA it is legal to get consent of the inmate to these questions. Do you want to be rusticated if your heart stops? Do you want aggressive treatments such as intubation and mechanical ventilation? Do you want antibiotics? Do you want tube or intravenous feeding if you can’t eat on your own? The hospice also assists in framing a will and record last wishes of the patient. Hospice also provides palliative care to reduce pain and suffering by administering sedatives, pain killers, psychiatric drugs etc. There are approved procedures and WHO guidelines on palliative care. A modern trend that is gaining support is called physician assisted suicide (PAS). This should not be confused with euthanasia or mercy killing. In PAS the decision to die rests with the patient. The physician merely prescribes a lethal dose of barbiturates and the patient is free to take it whenever he desires. Assisted suicide is legal in the states of Oregon, Vermont and Washington in USA. The book ends on a philosophical note. Dr Gawande visits Varanasi to immerse ashes of his father in Holy Ganges. There is a saying in Hindi. “To attain Moksha, one has to die!” let us therefore accept that we are mortals and be happy about that fact. Being Mortal is good book. I strongly urge you to read it.