Being Mortal (PB)

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.

I must admit I approached this book with some trepidation -- this book has been hyped up quite a bit, is written by a practicing surgeon and is about aging and terminal illnesses, mundane topics. But was I incredibly and pleasantly surprised! This book is one of the most useful books that I have read and is remarkable from beginning to end. Gawande starts off by making the point that unlike in the past, when death was sudden, there is now a prolonged period of aging and the inexorable decay of the body and faculties. He wonders how we reached a situation where the only option for the elderly is to get "institutionalised" and lose control of their lives. The book essentially focuses on the issues with the current medical approach towards terminal illnesses, especially of older people, and towards aging. As Gawande puts it, this approach concentrates on repair of health, even if it means just slightly prolonging the inevitable and tremendously increasing the pain, rather than on the sustenance of the soul. And this sustenance may mean different things for different people -- as one of his patients says, "the best thing in your life is when you can go yourself to the bathroom". One of the things that I liked about the book was its prescriptive nature -- it does not stop at just laying out the trouble with modern medical care. With real examples, he details what medical practitioners can do to overcome the above issues, and more importantly, what individuals can and should do when grappling with their own aging or that of their loved ones. Ultimately, the job of medicine is not to ensure health and survival but to enable well-being. And in this context, it is important to have difficult conversations and also knowing when to let go. This is the first book that I have read of Gawande and found him to be an impressive writer. The book is a fascinating and easy read despite the seriousness of the subject, and he has filled the book with personal anecdotes that are immensely relatable to. His brave description of his father's last days, who himself was a medical practitioner, add to the credibility of his arguments and enhance our learnings too. Parts of the book can be a bit depressing given an element of morbidness but I would strongly recommend this to any reader, whether she is elderly herself, has aging parents, or even otherwise. Pros: Superbly written, tremendously useful for everyone Cons: Slightly depressing perhaps

It is rare for a person to excel in multiple disciplines at the same time, but Dr Atul Gawande has succeeded in both medicine and writing. . .This book explores one of my favourite topics - Mortality and how humans react to it. It courageously raises the fact that quality of life is more important than its length. . What is wrong in present medical guidelines; to keep heart pumping even if there is no meaningful existence attached to it. . Written beautifully in an engaging non complex prose, it defends and represents vital insights into our policies and perceptions about life and death. . . End of life care needs continuous scrutiny and updation. . . I have read ' Checklist manifesto' also and cannot wait to read his other works. . Nice book for all medicos and nonmedicos who want to read very good and meaningful writing.

Perhaps the best book I have ever read. It has given my life new directions. Deeply grateful to the author for penning this book.

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.

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!

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.