BEING MORTAL: ATUL GAWANDE

Atul Gawande, a surgeon in a Boston hospital, first came to my attention with the book COMPLICATIONS, an exploration of what it takes to become good at something, in his case, surgery.  This book is completely different, arising from the death of his father, also a doctor, in Athens, Ohio.  It's a thorough exploration of end of life care, in assisted living places, hospitals, hospice and/home, where we all end up, alas.  Certainly, this is not a feel good book, but it's a book everyone should read, young or old because it's either about you or your parents.

Briefly, he sees most assisted living places most interested in running a tight ship, making sure things run on time, patients are taken care of, pills given, lives restricted for their own good.  And he has a problem with this: it takes away end of life autonomy, freedom of choice, what the patient may prefer.  And he goes into detail about those caregivers who have dared to think differently, allowing patients to decide how they want to lives their lives, allowing them freedom to eat, wake, or sleep when they want.  And they usually allow animals, children, plants, a normal life in fact into their places, making them as inviting and home like as they can, so different from the stereotype of the assisted living homes.  And these pioneers proved patients were happier, money was ultimately saved, that this could be done without costing more money.  Half of the book deals with this sort of thing, exploring the new horizons in end of life care, which in some cases may last for years.  The essential of this experience is make the experience as close to what the patient want, hopes for, not a tightly just a well oiled machine, organized and disciplined but lacking warmth and humanity.

The second part deals with end of life and the difficulty in trying to decide when its necessary to stop the cancer drugs, the feeding tube, the various surgeries but often ignore or forget to ask what the patients want.  He lives these difficulties when his father's begins to fail eventually dies. He also does research and begins talking about wishes with his patients, something he rarely did well before the death of his father.  It's important, he realizes, to ask the patient what they know, how they would like to spend the rest of their days, with family and/or hospice or a hospital, waiting for another round of chemo or surgery which may or may not extend life.  Doctors are taught to do everything possible to prolong life but Gawande asks: what kind of life?  Life may be prolonged but is it worth it if you are on a feeding tube, or a quadriplegic, or worst.  Asking these kinds of questions before things get towards the end of one's life are important.  And he realizes even if we ask the right questions, there is always uncertainty about results; nothing can be known for sure except that we will ultimately die.

I thought the book could have been much shorter and I am not sure I needed all the examples, the stories of various patients' ultimate demise.  His solutions are fairly straight forward and reasonable, nothing earth shattering that makes the reader go wow.  It's mostly common sense, but we too often just put it off talking about end of life choices until it's too late.  So for that reason alone, the book may be worth reading.