This book explores the shortcomings in medicine when it comes to preparing patients for death. Is the goal to extend life as far out as possible or to make sure that a person’s last days as well spent as possible? In Dr. Gawande’s view, doctors are more like mechanics charged with fixing problems in a deteriorating old car rather than caretakers whose job is to help maintain a patient’s dignity and quality of life until their last day. He sees this as misguided and this book is a plea to his profession to do better.
Dr. Gawande interviews hospice care professionals and other doctors, and examines different treatment options for people entering old age or diagnosed with a terminal illness. He also weaves patient’s stories and his own experience into the narrative, such as is own father’s decline and his experiences delivering devastating news of terminal illness to patients. Being Mortal is a thoughtful examination of what is important in life and how to make the final days of those near death as full of life as possible.
Frontline: Being Mortal—PBS television companion to the book.
‘Letting Go: What should medicine do when it can’t save your life?’ Dr. Gawande’s New Yorker essay that inspired the book.
What the professionals had to say: The Guardian review.
Buy on Amazon: Being Mortal: Medicine and What Matters in the End
Stuff of Interest:
tachycardic—a heart rate higher than normal, typically 100 bpm or more.
cutaneous mechanoreceptors—nerves and sensory receptors
skein—a tangled or complicated arrangement, state, or situation.
Lewis Thomas, physician-writer— quoted as being skeptical of the efficacy of hospital care in 1937: “If being in a hospital bed made a difference, it was mostly the difference produced by warmth, shelter, and food, and attentive, friendly care, and the matchless skill of the nurses in providing these things. Whether you survived or not depended on the natural history of the disease itself. Medicine made little or no difference.”
Hill Burton Act, 1946—Federal law that provided massive government funding for hospital construction. Within twenty years, over 9,000 medical facilities were built across the country.
Park Place—The first assisted living facility, opened in Portland in 1983 by Karen Brown Wilson.
Eden Alternative—a senior living alternative that has lots of pets, greenery, and few residents that receive personalized care. Designed to pursue the idea that a life worth living can be created, in this case, by focusing on food, homemaking, and community.
‘The Median Isn’t the Message‘, by Stephen J. Gould—Essay by the renowned scientist that Dr. Gawunde appreciates, but disagrees with its blind optimism.
Nelene Fox—woman who died from breast cancer but whose estate won an $89 million settlement posthumously from her insurance company for withholding coverage for experimental treatment that was later deemed ineffective.
‘Four Models of the Physician-Patient Relationship‘, by Ezekiel J. Emanuel and Linda L. Emanuel—a scholarly article describing the power dynamic between physicians and patients. Summarized here.