Being Mortal: Medicine and What Matters in the End
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Being Mortal: Medicine and What Matters in the End

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by Atul Gawande
     
 

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In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition

Overview


In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

Editorial Reviews

A Barnes & Noble Best Book of 2014

In his years as a surgeon, Gawande dedicated himself to doing whatever he could to save patients’ lives. But he also came to understand that there are limits to what medicine can do, and, perhaps, what it should do. In this heartfelt work, Gawande offers hard-won perspective on elder care, end-of-life treatments, and hospice practice. In the end, he argues, what truly matters is using medicine to offer comfort, and helping patients to face death on their own terms, in peace and with dignity. See all of the Best Nonfiction Books of 2014.

The New York Times - Janet Maslin
"I never expected that among the most meaningful experiences I'd have as a doctor—and, really, as a human being—would come from helping others deal with what medicine cannot do as well as what it can," [Gawande] writes. Being Mortal uses a clear, illuminating style to describe the medical facts and cases that have brought him to that understanding.
The New York Times Book Review - Sheri Fink
Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is "to enable well-being." If that sounds vague, Gawande has plenty of engaging and nuanced stories to leave the reader with a good sense of what he means…Being Mortal is a valuable contribution to the growing literature on aging, death and dying. It contains unsparing descriptions of bodily aging and the way it often takes us by surprise. Gawande is a gifted storyteller, and there are some stirring, even tear-inducing passages here. The writing can be evocative…The stories give a dignified voice to older people in the process of losing their independence. We see the world from their perspective, not just those of their physicians and worried family members.
From the Publisher

Being Mortal, Atul Gawande's masterful exploration of aging, death, and the medical profession's mishandling of both, is his best and most personal book yet.” —Boston Globe

“American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande's most powerful--and moving--book.” —Malcolm Gladwell

“Beautifully crafted . . . Being Mortal is a clear-eyed, informative exploration of what growing old means in the 21st century . . . a book I cannot recommend highly enough. This should be mandatory reading for every American. . . . it provides a useful roadmap of what we can and should be doing to make the last years of life meaningful.” —Time.com

“Masterful . . . Essential . . . For more than a decade, Atul Gawande has explored the fault lines of medicine . . . combining his years of experience as a surgeon with his gift for fluid, seemingly effortless storytelling . . . In Being Mortal, he turns his attention to his most important subject yet.” —Chicago Tribune

“Beautifully written . . . In his newest and best book, Gawande . . . has provided us with a moving and clear-eyed look at aging and death in our society, and at the harms we do in turning it into a medical problem, rather than a human one.” —The New York Review of Books

“Powerful.” —New York Magazine

“Atul Gawande's wise and courageous book raises the questions that none of us wants to think about . . . Remarkable.” —John Carey, The Sunday Times (UK)

“A deeply affecting, urgently important book--one not just about dying and the limits of medicine but about living to the last with autonomy, dignity, and joy.” —Katherine Boo

“Dr. Gawande's book is not of the kind that some doctors write, reminding us how grim the fact of death can be. Rather, he shows how patients in the terminal phase of their illness can maintain important qualities of life.” —Wall Street Journal (Best Books of 2014)

Being Mortal left me tearful, angry, and unable to stop talking about it for a week. . . . A surgeon himself, Gawande is eloquent about the inadequacy of medical school in preparing doctors to confront the subject of death with their patients. . . . it is rare to read a book that sparks with so much hard thinking.” —Nature

“We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. However it is not only medicine that is needed in one's declining years but life--a life with meaning, a life as rich and full as possible under the circumstances. Being Mortal is not only wise and deeply moving, it is an essential and insightful book for our times, as one would expect from Atul Gawande, one of our finest physician writers.” —Oliver Sacks

“Gawande's book is so impressive that one can believe that it may well [change the medical profession] . . . May it be widely read and inwardly digested.” —Diana Athill, Financial Times (UK)

“Eloquent, moving.” —The Economist (Best Books of 2014)

“A great read that leaves you better equipped to face the future, and without making you feel like you just took your medicine.” —Mother Jones (Best Books of 2014)

“Beautiful.” —New Republic

“Gawande displays the precision of his surgical craft and the compassion of a humanist . . . in a narrative that often attains the force and beauty of a novel . . . Only a precious few books have the power to open our eyes while they move us to tears. Atul Gawande has produced such a work. One hopes it is the spark that ignites some revolutionary changes in a field of medicine that ultimately touches each of us.” —Shelf Awareness (Best Books of 2014)

“A needed call to action, a cautionary tale of what can go wrong, and often does, when a society fails to engage in a sustained discussion about aging and dying.” —San Francisco Chronicle

Oliver Sacks

We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. However it is not only medicine that is needed in one's declining years but life--a life with meaning, a life as rich and full as possible under the circumstances. Being Mortal is not only wise and deeply moving, it is an essential and insightful book for our times, as one would expect from Atul Gawande, one of our finest physician writers.
Chicago Tribune

Masterful . . . Essential . . . For more than a decade, Atul Gawande has explored the fault lines of medicine . . . combining his years of experience as a surgeon with his gift for fluid, seemingly effortless storytelling . . . In Being Mortal, he turns his attention to his most important subject yet.
Nature

Being Mortal left me tearful, angry, and unable to stop talking about it for a week. . . . A surgeon himself, Gawande is eloquent about the inadequacy of medical school in preparing doctors to confront the subject of death with their patients. . . . it is rare to read a book that sparks with so much hard thinking.
San Francisco Chronicle

A needed call to action, a cautionary tale of what can go wrong, and often does, when a society fails to engage in a sustained discussion about aging and dying.
New Republic

Beautiful.
Boston Globe

Being Mortal, Atul Gawande's masterful exploration of aging, death, and the medical profession's mishandling of both, is his best and most personal book yet.
New York Magazine

Powerful.
The New York Review of Books

Beautifully written . . . In his newest and best book, Gawande . . . has provided us with a moving and clear-eyed look at aging and death in our society, and at the harms we do in turning it into a medical problem, rather than a human one.
Malcolm Gladwell

American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande's most powerful--and moving--book.
Katherine Boo

A deeply affecting, urgently important book--one not just about dying and the limits of medicine but about living to the last with autonomy, dignity, and joy.
Kirkus Reviews
2014-07-14
A prominent surgeon and journalist takes a cleareyed look at aging and death in 21st-century America. Modern medicine can perform miracles, but it is also only concerned with preserving life rather than dealing with end-of-life issues. Drawing on his experiences observing and helping terminally ill patients, Gawande (The Checklist Manifesto: How to Get Things Right, 2009, etc.) offers a timely account of how modern Americans cope with decline and mortality. He points out that dying in America is a lonely, complex business. Before 1945, people could count on spending their last days at home. Now, most die in institutional settings, usually after trying every medical procedure possible to head off the inevitable. Quality of life is often sacrificed, in part because doctors lack the ability to help patients negotiate a bewildering array of medical and nonmedical options. Many, like Gawande's mother-in-law, Alice, find that they must take residence in senior housing or assisted care facilities due to the fact that no other reasonable options exist. But even the most well-run of these "homes" are problematic because they can only offer sterile institutional settings that restrict independence and can cause psychological distress. Moving in with adult children is also difficult due to the tensions and conflicts that inevitably arise. Yet the current system shows signs of reform. Rather than simply inform patients about their options or tell them what to do, some doctors, including the author, are choosing to offer the guidance that helps patients make their own decisions regarding treatment options and outcomes. By confronting the reality rather than pretending it can be beaten and understanding that "there are times where the cost of pushing exceeds its value," the medical establishment can offer the kind of compassion that allows for more humane ways to die. As Gawande reminds readers, "endings matter." A sensitive, intelligent and heartfelt examination of the processes of aging and dying.
Library Journal
05/15/2014
Leading surgeon, Harvard medical professor, and best-selling author, Gawande is also a staff writer at The New Yorker, which published the National Magazine Award-winning article that serves as the basis for this study of how contemporary medicine can do a better, more humane job of managing death and dying.

Product Details

ISBN-13:
9780805095159
Publisher:
Holt, Henry & Company, Inc.
Publication date:
10/07/2014
Pages:
304
Sales rank:
355
Product dimensions:
5.80(w) x 8.30(h) x 1.30(d)

Read an Excerpt

Introduction

I learned about a lot of things in medical school, but mortality wasn’t one of them. Although I was given a dry, leathery corpse to dissect in my first term, that was solely a way to learn about human anatomy. Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives, and how it affects those around them seemed beside the point. The way we saw it, and the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.

The one time I remember discussing mortality was during an hour we spent on The Death of Ivan Ilyich, Tolstoy’s classic novella. It was in a weekly seminar called Patient-Doctor—part of the school’s effort to make us more rounded and humane physicians. Some weeks we would practice our physical examination etiquette; other weeks we’d learn about the effects of socioeconomics and race on health. And one afternoon we contemplated the suffering of Ivan Ilyich as he lay ill and worsening from some unnamed, untreatable disease.

In the story, Ivan Ilyich is forty-five years old, a midlevel Saint Petersburg magistrate whose life revolves mostly around petty concerns of social status. One day, he falls off a stepladder and develops a pain in his side. Instead of abating, the pain gets worse, and he becomes unable to work. Formerly an “intelligent, polished, lively and agreeable man,” he grows depressed and enfeebled. Friends and colleagues avoid him. His wife calls in a series of ever more expensive doctors. None of them can agree on a diagnosis, and the remedies they give him accomplish nothing. For Ilyich, it is all torture, and he simmers and rages at his situation.

“What tormented Ivan Ilyich most,” Tolstoy writes, “was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and he only need keep quiet and undergo a treatment and then something very good would result.” Ivan Ilyich has flashes of hope that maybe things will turn around, but as he grows weaker and more emaciated he knows what is happening. He lives in mounting anguish and fear of death. But death is not a subject that his doctors, friends, or family can countenance. That is what causes him his most profound pain.

“No one pitied him as he wished to be pitied,” writes Tolstoy. “At certain moments after prolonged suffering he wished most of all (though he would have been ashamed to confess it) for someone to pity him as a sick child is pitied. He longed to be petted and comforted. He knew he was an important functionary, that he had a beard turning grey, and that therefore what he longed for was impossible, but still he longed for it.”

As we medical students saw it, the failure of those around Ivan Ilyich to offer comfort or to acknowledge what is happening to him was a failure of character and culture. The latenineteenth-century Russia of Tolstoy’s story seemed harsh and almost primitive to us. Just as we believed that modern medicine could probably have cured Ivan Ilyich of whatever disease he had, so too we took for granted that honesty and kindness were basic responsibilities of a modern doctor. We were confident that in such a situation we would act compassionately.

What worried us was knowledge. While we knew how to sympathize, we weren’t at all certain we would know how to properly diagnose and treat. We paid our medical tuition to learn about the inner process of the body, the intricate mechanisms of its pathologies, and the vast trove of discoveries and technologies that have accumulated to stop them. We didn’t imagine we needed to think about much else. So we put Ivan Ilyich out of our heads.

Yet within a few years, when I came to experience surgical training and practice, I encountered patients forced to confront the realities of decline and mortality, and it did not take long to realize how unready I was to help them.

I began writing when I was a junior surgical resident, and in one of my very first essays, I told the story of a man whom I called Joseph Lazaroff. He was a city administrator who’d lost his wife to lung cancer a few years earlier. Now, he was in his sixties and suffering from an incurable cancer himself—a widely metastatic prostate cancer. He had lost more than fifty pounds. His abdomen, scrotum, and legs had filled with fluid. One day, he woke up unable to move his right leg or control his bowels. He was admitted to the hospital, where I met him as an intern on the neurosurgical team. We found that the cancer had spread to his thoracic spine, where it was compressing his spinal cord. The cancer couldn’t be cured, but we hoped it could be treated. Emergency radiation, however, failed to shrink the cancer, and so the neurosurgeon offered him two options: comfort care or surgery to remove the growing tumor mass from his spine. Lazaroff chose surgery. My job, as the intern on the neurosurgery service, was to get his written confirmation that he understood the risks of the operation and wished to proceed.

I’d stood outside his room, his chart in my damp hand, trying to figure out how to even broach the subject with him. The hope was that the operation would halt the progression of his spinal cord damage. It wouldn’t cure him, or reverse his paralysis, or get him back to the life he had led. No matter what we did he had at most a few months to live, and the procedure was inherently dangerous. It required opening his chest, removing a rib, and collapsing a lung to get at his spine. Blood loss would be high. Recovery would be difficult. In his weakened state, he faced considerable risks of debilitating complications afterward. The operation posed a threat of both worsening and shortening his life. But the neurosurgeon had gone over these dangers, and Lazaroff had been clear that he wanted the operation. All I had to do was go in and take care of the paperwork.

Lying in his bed, Lazaroff looked gray and emaciated. I said that I was an intern and that I’d come to get his consent for surgery, which required confirming that he was aware of the risks. I said that the operation could remove the tumor but leave him with serious complications, such as paralysis or a stroke, and that it could even prove fatal. I tried to sound clear without being harsh, but my discussion put his back up. Likewise when his son, who was in the room, questioned whether heroic measures were a good idea. Lazaroff didn’t like that at all.

“Don’t you give up on me,” he said. “You give me every chance I’ve got.” Outside the room, after he signed the form, the son took me aside. His mother had died on a ventilator in intensive care, and at the time his father had said he did not want anything like that to happen to him. But now he was adamant about doing “everything.”

I believed then that Mr. Lazaroff had chosen badly, and I still believe this. He chose badly not because of all the dangers but because the operation didn’t stand a chance of giving him what he really wanted: his continence, his strength, the life he had previously known. He was pursuing little more than a fantasy at the risk of a prolonged and terrible death—which was precisely what he got.

The operation was a technical success. Over eight and a half hours, the surgical team removed the mass invading his spine and rebuilt the vertebral body with acrylic cement. The pressure on his spinal cord was gone. But he never recovered from the procedure. In intensive care, he developed respiratory failure, a systemic infection, blood clots from his immobility, then bleeding from the blood thinners to treat them. Each day we fell further behind. We finally had to admit he was dying. On the fourteenth day, his son told the team that we should stop.

It fell to me to take Lazaroff off the artificial ventilator that was keeping him alive. I checked to make sure that his morphine drip was turned up high, so he wouldn’t suffer from air hunger. I leaned close and, in case he could hear me, said I was going to take the breathing tube out of his mouth. He coughed a couple of times when I pulled it out, opened his eyes briefly, and closed them. His breathing grew labored, then stopped. I put my stethoscope on his chest and heard his heart fade away.

Now, more than a decade after I first told Mr. Lazaroff’s story, what strikes me most is not how bad his decision was but how much we all avoided talking honestly about the choice before him. We had no difficulty explaining the specific dangers of various treatment options, but we never really touched on the reality of his disease. His oncologists, radiation therapists, surgeons, and other doctors had all seen him through months of treatments for a problem that they knew could not be cured. We could never bring ourselves to discuss the larger truth about his condition or the ultimate limits of our capabilities, let alone what might matter most to him as he neared the end of his life. If he was pursuing a delusion, so were we. Here he was in the hospital, partially paralyzed from a cancer that had spread throughout his body. The chances that he could return to anything like the life he had even a few weeks earlier were zero. But admitting this and helping him cope with it seemed beyond us. We offered no acknowledgment or comfort or guidance. We just had another treatment he could undergo. Maybe something very good would result.

We did little better than Ivan Ilyich’s primitive nineteenthcentury doctors—worse, actually, given the new forms of physical torture we’d inflicted on our patient. It is enough to make you wonder, who are the primitive ones.

Modern scientific capability has profoundly altered the course of human life. People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical world have proved alarmingly unprepared for it.

This reality has been largely hidden, as the final phases of life become less familiar to people. As recently as 1945, most deaths occurred in the home. By the 1980s, just 17 percent did. Those who somehow did die at home likely died too suddenly to make it to the hospital—say, from a massive heart attack, stroke, or violent injury—or were too isolated to get somewhere that could provide help. Across not just the United States but also the entire industrialized world, the experience of advanced aging and death has shifted to hospitals and nursing homes.

When I became a doctor, I crossed over to the other side of the hospital doors and, although I had grown up with two doctors for parents, everything I saw was new to me. I had certainly never seen anyone die before and when I did it came as a shock. That wasn’t because it made me think of my own mortality. Somehow the concept didn’t occur to me, even when I saw people my own age die. I had a white coat on; they had a hospital gown. I couldn’t quite picture it the other way round. I could, however, picture my family in their places. I’d seen multiple family members—my wife, my parents, and my children—go through serious, life-threatening illnesses. Even under dire circumstances, medicine had always pulled them through. The shock to me therefore was seeing medicine not pull people through. I knew theoretically that my patients could die, of course, but every actual instance seemed like a violation, as if the rules I thought we were playing by were broken. I don’t know what game I thought this was, but in it we always won.

Dying and death confront every new doctor and nurse. The first times, some cry. Some shut down. Some hardly notice. When I saw my first deaths, I was too guarded to cry. But I dreamt about them. I had recurring nightmares in which I’d find my patients’ corpses in my house—in my own bed.

“How did he get here?” I’d wonder in panic.

I knew I would be in huge trouble, maybe criminal trouble, if I didn’t get the body back to the hospital without getting caught. I’d try to lift it into the back of my car, but it would be too heavy. Or I’d get it in, only to find blood seeping out like black oil until it overflowed the trunk. Or I’d actually get the corpse to the hospital and onto a gurney, and I’d push it down hall after hall, trying and failing to find the room where the person used to be. “Hey!” someone would shout and start chasing me. I’d wake up next to my wife in the dark, clammy and tachycardic. I felt that I’d killed these people. I’d failed.

Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things. I knew these truths abstractly, but I didn’t know them concretely— that they could be truths not just for everyone but also for this person right in front of me, for this person I was responsible for.

The late surgeon Sherwin Nuland, in his classic book How We Die, lamented, “The necessity of nature’s final victory was expected and accepted in generations before our own. Doctors were far more willing to recognize the signs of defeat and far less arrogant about denying them.” But as I ride down the runway of the twenty-first century, trained in the deployment of our awesome arsenal of technology, I wonder exactly what being less arrogant really means.

You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. It is a deep satisfaction very much like the one that a carpenter experiences in restoring a fragile antique chest or that a science teacher experiences in bringing a fifth grader to that sudden, mind-shifting recognition of what atoms are. It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with a problem you cannot solve.

There’s no escaping the tragedy of life, which is that we are all aging from the day we are born. One may even come to understand and accept this fact. My dead and dying patients don’t haunt my dreams anymore. But that’s not the same as saying one knows how to cope with what cannot be mended. I am in a profession that has succeeded because of its ability to fix. If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering.

This experiment of making mortality a medical experience is just decades old. It is young. And the evidence is it is failing.

this is a book about the modern experience of mortality— about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong. As I pass a decade in surgical practice and become middleaged myself, I find that neither I nor my patients find our current state tolerable. But I have also found it unclear what the answers should be, or even whether any adequate ones are possible. I have the writer’s and scientist’s faith, however, that by pulling back the veil and peering in close, a person can make sense of what is most confusing or strange or disturbing.

You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions—nursing homes and intensive care units—where regimented, anonymous routines cut us off from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers.

I wrote this book in the hope of understanding what has happened. Mortality can be a treacherous subject. Some will be alarmed by the prospect of a doctor’s writing about the inevitability of decline and death. For many, such talk, however carefully framed, raises the specter of a society readying itself to sacrifice its sick and aged. But what if the sick and aged are already being sacrificed—victims of our refusal to accept the inexorability of our life cycle? And what if there are better approaches, right in front of our eyes, waiting to be recognized?

Copyright © 2014 by Atul Gawande

Meet the Author


Atul Gawande is author of four bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon as one of the ten best books of 2007; The Checklist Manifesto; and his most recent, Being Mortal. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Executive Director of Ariadne Labs, a joint center for health systems innovation, and chairman of Lifebox, a nonprofit organization making surgery safer globally. He and his wife have three children and live in Newton, Massachusetts.

Brief Biography

Hometown:
Newton, Massachusetts
Date of Birth:
November 5, 1965
Place of Birth:
Brooklyn, New York
Education:
B.A.S., Stanford University, 1987; M.A., Oxford University, 1989; M.D., Harvard Medical School, 1995

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Being Mortal: Medicine and What Matters in the End 4.5 out of 5 based on 7 ratings. 100 reviews.
Jo_Kline_Cebuhar More than 1 year ago
It is the best book I have read on how to effectively deal with end-of-life choices (and I've read a ton of them). The most notable characteristic of the book is Dr. Gawande's honest reflections on his past shortcomings as a physician. His awakenings came from being truly mindful of the passing of several patients and then of his own father. It contains practical guidance for having a meaningful conversation with your physician (or your patient, doc) about realistic choices for care at life's end. An invaluable resource for anyone who is now witness to the final chapter of life or may be in the future (come to think of it, that's every one of us . . .).
Anonymous More than 1 year ago
I usually read fiction. This book answers so many questions I have been pondering of late, and it gives me hope. It's for everyone, young, old or in between.
Anonymous More than 1 year ago
As a senior citizen and someone who works with hospice patients, I felt the book was a treasure! It helped my understanding of the aging process. PiPart,Los Angeles
Swampgal2 More than 1 year ago
Buying two more copies this morning, one for a medical student and another to circulate among the staff of my parents' continuing care community. This is an important book for any of us concerned with aging-- of parents, family, ourselves.  Dr. Gawande gives shape and voice to issues we need to be discussing. 
gjbwi More than 1 year ago
Great book. As I struggle with my own health problems, this book gives me perspective.
Anonymous More than 1 year ago
This book addresses in a very captivating way some of the moral and ethical questions that need to be discussed about illness and dying.    A compassionate and smart book about our death and dying policies and how they affect real people. 
ThinkerbelleVG More than 1 year ago
Everyone would gain so much by reading this book, but for medical professionals, it should be positively required. Dr. Gawande writes in a way that touches the heart of being human with compassion, insight, understanding. His medical knowledge and frank revelations are wonderful. We are all going to die. Everyone we know will die - but how we approach it, most especially medically, can mean a world of difference. I highly recommend the book and applaud Dr. Gawande. Thank you.
John_F48 More than 1 year ago
Atul presents a thought provoking discussion of end-of-life issues in our post-industrial age by discussing what we all fear as we approach retirement. What do we do when our bodies begin to breakdown to the point that we can no longer function well in our homes and apartments. The industrial approach is warehousing to rest homes where the staff regiments our lives to their convenience in an antiseptic and sterile environment that is frequently depressing and expensive. He contrasts that to his father's former homeland, India, where the family is a community that supports its older members usually at the expense of an older son. It is a way of life that is disappearing in India today because of India's inustrialization process. He discusses the quality of life issues, some innovative approaches to living for the middle-class and below, and some hard decisions that patients and doctors must face when recognized terminal conditions become present. It is well written and should be considered those closest to the issues raised.
Anonymous More than 1 year ago
Beautifully written! I have a better understanding of how the healthcare system is failing our elderly and the terminally sick in providing the information that is needed to make the right decisions. Best book I have read in a long time.
tetonpilates More than 1 year ago
A sensitive and important book about a topic we aren't very good at discussing.  I have aging parents and in-laws, and the issues Dr. Gawande raises in "Being Mortal" hit pretty close to home.  Reading this made me think about my own wishes for the end of my life, and whether I've communicated them to my loved ones (answer: not yet)  He is a humble and intelligent writer, and I appreciate the questions he raises about the medical field and how physicians and caregivers aren't well-trained to help patients navigate the hard conversations that are necessary.  I "enjoyed" this even though it stirred some uneasy thoughts for me.  Highly recommended. 
Anonymous More than 1 year ago
This book is a lifesaver and puts ageing into the proper perspective. I've read several articles and learned of new programs (Honoring Choices for example) about how people can better control their end-of-life decisions. This book explains the ageing process from both a physiological and psychological perspective. It is caring, informative and wonderful. It has really helped me in dealing with my older parents, and in managing my own affairs to be sure I am not a burden in my old age and get to live the life I want.
DoranneLongPTMS More than 1 year ago
This is a must-read book; we are all aging, going to have health issues, and need guidance in navigating the health-care system, whether we like it or not! We need to be aware of the costs and risks of prolonging our lives, and those of our loved ones. Atul shares his own personal, as well as professional journey as a surgeon, in learning to ask others, what are their fears and concerns; what is important to them; what are their goals, and what are the limits to what they are willing to do. As a fellow health care provider, and daughter, I will be more sensitive to provide guidance while being respectful of others' wishes.
Anonymous More than 1 year ago
Dr Gawande writes about everyone's inevitable aging and/or dying. He follows family and patients, who are not all elderly, on this journey, making the book a very intimate read. The book is well researched as he recounts visits with innovators in elder living and palliative medicine. He writes in a warm, engaging manner that is not at all depressing, but hopeful, and at times even joyful. He faces our greatest fears about pain, and losing independence and choice in life, as we age and lose ability to function. He goes beyond death with dignity, to death surrounded by those we love, without pain (or almost so), and filled with peace. Read it, share it with those you love, and more importantly talk about it.
Anonymous More than 1 year ago
This book was recommended to me by a friend of my elderly mother. It was more than worth reading, bringing the reader up to date on how we have arrived at the way we treat our elderly, as well as what questions to ask as we help our elderly family members (and ourselves!) through the end years of our lives. The writer's style is engaging, and he uses enough case histories to clearly make his points. Since I finished it, I too have recommended it to several of my friends who have agreed that it was both well written and timely.
Anonymous More than 1 year ago
A real look at a chapter of our life that we dont seem to talk about. Thank you for the conversations about facing mortality, the line in the sand, what is worth pressing for and what is a hard stop. Thank you.
Anonymous More than 1 year ago
First "tell it like it is" approach to end of life issues that I have been able to find. Too often, family chooses to resist discussion of any of this. Will tray forcing this book on my children and maybe they will read it!
Anonymous More than 1 year ago
We all know that we are mortal and that someday we we will die. But this book is not about death. It's about life in the period after we can no longer care for our selves due to illness, accident, or old age and the day we draw our last breath. It's about setting priorities for our lives after the end is in sight so that our remaining days are spent fulfilling our own goals and not someone else's. It's also a message to the caretakers, friends, and relatives around us to understand this so they can assist in reaching those goals in our final days.
Anonymous More than 1 year ago
An honest, refreshing and brave step forward. This doctor moves beyond the limitations of traditional medical training- and his own fears- and shines light on an essential truth we might otherwise have missed......
Anonymous 10 days ago
Anonymous 11 days ago
This is a conformation of the fundamental belief that I have about the process of aging, illness, care and dying. Also having to appropriate approach about honoring the wishes of ones loved one. Excellent, I enjoyed reading every page. Andria P. Harris.
Anonymous 6 months ago
Anonymous 8 months ago
I'm tired of all the warriors results on everything and won't you LOSERS post your clan junk somwhere else
Anonymous 9 months ago
Anonymous More than 1 year ago
Most important book I have read in years. On an individual level, it helps inform on the choices we will need to make for ourselves and for aging relatives. On a broader scale, it raises issues (in a nonpartisan and non-judgemental way) that need attention at a national policy level. The confluence of our healthcare systems' problems and the aging of the population create a huge risk to our country's future. It should be required reading for everyone.
Alaska1940 More than 1 year ago
Great book, so glad I read it. I learned a lot. More books like this should be written. Most folks do not stop to think about these things - we all think it happens to someone else. Thank you Atul Gawande. I believe PCP's should recommend this book.