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Book Review: Being Mortal by Atul Gawande

Atul Gawande‘s book Being Mortal is on the New York Times best seller list. I did not want to read it but a friend who is an M.D. gave it to me and I thought it had an important theme. It is about the American way of death. We live in a death denying culture and I am society’s child. Yes, we will eventually all perish. These bones and these tissues will decline and fail. I would expect the author to be realistic but too often I felt as if I were being dragged into a bleak, black hole. Even while writing this review, it is difficult to throw off the shroud of pessimism the book generates. I agree with Woody Allen who said: “I am not afraid of death. I just don’t want to be there when it happens.”

To begin with, Gawande is an Indian-American surgeon, a staff writer for the New Yorker and a Harvard professor. He writes from personal experience. His one brush with mortality in medical school was an hour spent discussing Tolstoy’sThe Death of Ivan Ilyich. In that novel the protagonist’s mystery illness deprived him of his humanity and his dignity. Due to this limited study of end of life issues, he rails against treatment that inflicts endless suffering to give a small sliver of temporary benefit. We are made privy to grotesque surgeries and chemotherapy treatments with hideous side effects. He also has some strong opinions about assisted living and nursing homes. It is said the elderly fear loss of independence more than death. Concerned relatives will often force decisions that are not choices. Is it better to have repeated falls in ones own home than to be safely but miserably seated in a wheel chair in an institution?

Every point the author makes he supports with empirical evidence. He even chronicles the last days of his own father, also a surgeon. My favorite anecdote was about a colleague who was in charge of a nursing home who was acutely aware of the three plagues of that existence: boredom, helplessness, and loneliness. His solution? Cats, dogs, birds and children. He brought in two cats, four dogs and a whole bunch of birds. Staff members were encouraged to bring in their children after school to hang out. Plastic plants were replaced with real ones. The results were stunning. One patient was near death when he was given two parakeets to care for. His recovery was so complete he was able to return to his home.

Read this book but be aware that some of the subject matter is gruesome. It has been said that doctors are the new demi-gods and the hospitals their cathedrals. Modern science and technology have created wondrous, miraculous cures. This book asks the question when is it time to accept the inevitable, when is enough, enough?

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