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

4.5 103
by Atul Gawande, Robert Petkoff (Read by)
 

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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 of aging and death, the

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

Library Journal - Audio
★ 01/01/2015
Gawande presents problems and potential solutions to the question of how we can best address our mortality. Through stories and research he shows that we are shifting from a highly medicalized end of life to an experience in which we can have some sort of meaning. Surgeon, writer, and public health researcher Gawande asks how we can live out our later years in the way we desire and how best to talk to our health-care providers to achieve that. He also discusses how health-care providers can and should approach talking to aging patients and their families. Robert Petkoff reads the book in a clear, distinct voice. The book is written from the first person and so the narration comes across very well. Listeners will gain great insight into ways of thinking about the important issues of facing mortality. VERDICT An excellent book for everyone but of particular interest to health-care providers and those approaching their later years or caring for the elderly.—Eric Albright, Tufts Univ. Health Sciences Lib., Boston
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.
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.
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

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.
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.

Product Details

ISBN-13:
9781427244239
Publisher:
Macmillan Audio
Publication date:
10/07/2014
Edition description:
Unabridged
Pages:
7
Sales rank:
153,215
Product dimensions:
5.90(w) x 5.10(h) x 0.90(d)

Read an Excerpt

Being Mortal

Medicine and What Matters in the End


By Atul Gawande

Henry Holt and Company

Copyright © 2014 Atul Gawande
All rights reserved.
ISBN: 978-1-62779-055-0



CHAPTER 1

The Independent Self


Growing up, I never witnessed serious illness or the difficulties of old age. My parents, both doctors, were fit and healthy. They were immigrants from India, raising me and my sister in the small college town of Athens, Ohio, so my grandparents were far away. The one elderly person I regularly encountered was a woman down the street who gave me piano lessons when I was in middle school. Later she got sick and had to move away, but it didn't occur to me to wonder where she went and what happened to her. The experience of a modern old age was entirely outside my perception.

In college, however, I began dating a girl in my dorm named Kathleen, and in 1985, on a Christmas visit to her home in Alexandria, Virginia, I met her grandmother Alice Hobson, who was seventy-seven at the time. She struck me as spirited and independent minded. She never tried to disguise her age. Her undyed white hair was brushed straight and parted on one side, Bette Davis–style. Her hands were speckled with age spots, and her skin was crinkled. She wore simple, neatly pressed blouses and dresses, a bit of lipstick, and heels long past when others would have considered it advisable.

As I came to learn over the years—for I would eventually marry Kathleen—Alice grew up in a rural Pennsylvania town known for its flower and mushroom farms. Her father was a flower farmer, growing carnations, marigolds, and dahlias, in acres of greenhouses. Alice and her siblings were the first members of their family to attend college. At the University of Delaware, Alice met Richmond Hobson, a civil engineering student. Thanks to the Great Depression, it wasn't until six years after their graduation that they could afford to get married. In the early years, Alice and Rich moved often for his work. They had two children, Jim, my future father-in-law, and then Chuck. Rich was hired by the Army Corps of Engineers and became an expert in large dam and bridge construction. A decade later, he was promoted to a job working with the corps's chief engineer at headquarters outside Washington, DC, where he remained for the rest of his career. He and Alice settled in Arlington. They bought a car, took road trips far and wide, and put away some money, too. They were able to upgrade to a bigger house and send their brainy kids off to college without need of loans.

Then, on a business trip to Seattle, Rich had a sudden heart attack. He'd had a history of angina and took nitroglycerin tablets to relieve the occasional bouts of chest pain, but this was 1965, and back then doctors didn't have much they could do about heart disease. He died in the hospital before Alice could get there. He was just sixty years old. Alice was fifty-six.

With her pension from the Army Corps of Engineers, she was able to keep her Arlington home. When I met her, she'd been living on her own in that house on Greencastle Street for twenty years. My in-laws, Jim and Nan, were nearby, but Alice lived completely independently. She mowed her own lawn and knew how to fix the plumbing. She went to the gym with her friend Polly. She liked to sew and knit and made clothes, scarves, and elaborate red-and-green Christmas stockings for everyone in the family, complete with a button-nosed Santa and their names across the top. She organized a group that took an annual subscription to attend performances at the Kennedy Center for the Performing Arts. She drove a big V8 Chevrolet Impala, sitting on a cushion to see over the dashboard. She ran errands, visited family, gave friends rides, and delivered meals-on-wheels for those with more frailties than herself.

As time went on, it became hard not to wonder how much longer she'd be able to manage. She was a petite woman, five feet tall at most, and although she bristled when anyone suggested it, she lost some height and strength with each passing year. When I married her granddaughter, Alice beamed and held me close and told me how happy the wedding made her, but she'd become too arthritic to share a dance with me. And still she remained in her home, managing on her own.

When my father met her, he was surprised to learn she lived by herself. He was a urologist, which meant he saw many elderly patients, and it always bothered him to find them living alone. The way he saw it, if they didn't already have serious needs, they were bound to develop them, and coming from India he felt it was the family's responsibility to take the aged in, give them company, and look after them. Since arriving in New York City in 1963 for his residency training, my father had embraced virtually every aspect of American culture. He gave up vegetarianism and discovered dating. He got a girlfriend, a pediatrics resident from a part of India where they didn't speak his language. When he married her, instead of letting my grandfather arrange his marriage, the family was scandalized. He became a tennis enthusiast, president of the local Rotary Club, and teller of bawdy jokes. One of his proudest days was July 4, 1976, the country's bicentennial, when he was made an American citizen in front of hundreds of cheering people in the grandstand at the Athens County Fair between the hog auction and the demolition derby. But one thing he could never get used to was how we treat our old and frail—leaving them to a life alone or isolating them in a series of anonymous facilities, their last conscious moments spent with nurses and doctors who barely knew their names. Nothing could have been more different from the world he had grown up in.

* * *

MY FATHER'S FATHER had the kind of traditional old age that, from a Western perspective, seems idyllic. Sitaram Gawande was a farmer in a village called Uti, some three hundred miles inland from Mumbai, where our ancestors had cultivated land for centuries. I remember visiting him with my parents and sister around the same time I met Alice, when he was more than a hundred years old. He was, by far, the oldest person I'd ever known. He walked with a cane, stooped like a bent stalk of wheat. He was so hard of hearing that people had to shout in his ear through a rubber tube. He was weak and sometimes needed help getting up from sitting. But he was a dignified man, with a tightly wrapped white turban, a pressed, brown argyle cardigan, and a pair of old-fashioned, thick-lensed, Malcolm X–style spectacles. He was surrounded and supported by family at all times, and he was revered—not in spite of his age but because of it. He was consulted on all important matters—marriages, land disputes, business decisions—and occupied a place of high honor in the family. When we ate, we served him first. When young people came into his home, they bowed and touched his feet in supplication.

In America, he would almost certainly have been placed in a nursing home. Health professionals have a formal classification system for the level of function a person has. If you cannot, without assistance, use the toilet, eat, dress, bathe, groom, get out of bed, get out of a chair, and walk—the eight "Activities of Daily Living"—then you lack the capacity for basic physical independence. If you cannot shop for yourself, prepare your own food, maintain your housekeeping, do your laundry, manage your medications, make phone calls, travel on your own, and handle your finances—the eight "Independent Activities of Daily Living"—then you lack the capacity to live safely on your own.

My grandfather could perform only some of the basic measures of independence, and few of the more complex ones. But in India, this was not of any dire consequence. His situation prompted no family crisis meeting, no anguished debates over what to do with him. It was clear that the family would ensure my grandfather could continue to live as he desired. One of my uncles and his family lived with him, and with a small herd of children, grandchildren, nieces, and nephews nearby, he never lacked for help.

The arrangement allowed him to maintain a way of life that few elderly people in modern societies can count on. The family made it possible, for instance, for him to continue to own and manage his farm, which he had built up from nothing—indeed, from worse than nothing. His father had lost all but two mortgaged acres and two emaciated bulls to a moneylender when the harvest failed one year. He then died, leaving Sitaram, his eldest son, with the debts. Just eighteen years old and newly married, Sitaram was forced to enter into indentured labor on the family's two remaining acres. At one point, the only food he and his bride could afford was bread and salt. They were starving to death. But he prayed and stayed at the plow, and his prayers were answered. The harvest was spectacular. He was able to not only put food on the table but also pay off his debts. In subsequent years, he expanded his two acres to more than two hundred. He became one of the richest landowners in the village and a moneylender himself. He had three wives, all of whom he outlived, and thirteen children. He emphasized education, hard work, frugality, earning your own way, staying true to your word, and holding others strictly accountable for doing the same. Throughout his life, he awoke before sunrise and did not go to bed until he'd done a nighttime inspection of every acre of his fields by horse. Even when he was a hundred he would insist on doing this. My uncles were worried he'd fall—he was weak and unsteady—but they knew it was important to him. So they got him a smaller horse and made sure that someone always accompanied him. He made the rounds of his fields right up to the year he died.

Had he lived in the West, this would have seemed absurd. It isn't safe, his doctor would say. If he persisted, then fell, and went to an emergency room with a broken hip, the hospital would not let him return home. They'd insist that he go to a nursing home. But in my grandfather's premodern world, how he wanted to live was his choice, and the family's role was to make it possible.

My grandfather finally died at the age of almost a hundred and ten. It happened after he hit his head falling off a bus. He was going to the courthouse in a nearby town on business, which itself seems crazy, but it was a priority to him. The bus began to move while he was getting off and, although he was accompanied by family, he fell. Most probably, he developed a subdural hematoma—bleeding inside his skull. My uncle got him home, and over the next couple of days he faded away. He got to live the way he wished and with his family around him right to the end.

* * *

FOR MOST OF human history, for those few people who actually survived to old age, Sitaram Gawande's experience was the norm. Elders were cared for in multigenerational systems, often with three generations living under one roof. Even when the nuclear family replaced the extended family (as it did in northern Europe several centuries ago), the elderly were not left to cope with the infirmities of age on their own. Children typically left home as soon as they were old enough to start families of their own. But one child usually remained, often the youngest daughter, if the parents survived into senescence. This was the lot of the poet Emily Dickinson, in Amherst, Massachusetts, in the mid-nineteenth century. Her elder brother left home, married, and started a family, but she and her younger sister stayed with their parents until they died. As it happened, Emily's father lived to the age of seventy-one, by which time she was in her forties, and her mother lived even longer. She and her sister ended up spending their entire lives in the parental home.

As different as Emily Dickinson's parents' life in America seems from that of Sitaram Gawande's in India, both relied on systems that shared the advantage of easily resolving the question of care for the elderly. There was no need to save up for a spot in a nursing home or arrange for meals-on-wheels. It was understood that parents would just keep living in their home, assisted by one or more of the children they'd raised. In contemporary societies, by contrast, old age and infirmity have gone from being a shared, multigenerational responsibility to a more or less private state—something experienced largely alone or with the aid of doctors and institutions. How did this happen? How did we go from Sitaram Gawande's life to Alice Hobson's?

One answer is that old age itself has changed. In the past, surviving into old age was uncommon, and those who did survive served a special purpose as guardians of tradition, knowledge, and history. They tended to maintain their status and authority as heads of the household until death. In many societies, elders not only commanded respect and obedience but also led sacred rites and wielded political power. So much respect accrued to the elderly that people used to pretend to be older than they were, not younger, when giving their age. People have always lied about how old they are. Demographers call the phenomenon "age heaping" and have devised complex quantitative contortions to correct for all the lying in censuses. They have also noticed that, during the eighteenth century, in the United States and Europe, the direction of our lies changed. Whereas today people often understate their age to census takers, studies of past censuses have revealed that they used to overstate it. The dignity of old age was something to which everyone aspired.

But age no longer has the value of rarity. In America, in 1790, people aged sixty-five or older constituted less than 2 percent of the population; today, they are 14 percent. In Germany, Italy, and Japan, they exceed 20 percent. China is now the first country on earth with more than 100 million elderly people.

As for the exclusive hold that elders once had on knowledge and wisdom, that, too, has eroded, thanks to technologies of communication—starting with writing itself and extending to the Internet and beyond. New technology also creates new occupations and requires new expertise, which further undermines the value of long experience and seasoned judgment. At one time, we might have turned to an old-timer to explain the world. Now we consult Google, and if we have any trouble with the computer we ask a teenager.

Perhaps most important of all, increased longevity has brought about a shift in the relationship between the young and the old. Traditionally, surviving parents provided a source of much-needed stability, advice, and economic protection for young families seeking pathways to security. And because landowners also tended to hold on to their property until death, the child who sacrificed everything to care for the parents could expect to inherit the whole homestead, or at least a larger portion than a child who moved away. But once parents were living markedly longer lives, tension emerged. For young people, the traditional family system became less a source of security than a struggle for control—over property, finances, and even the most basic decisions about how they could live.

And indeed, in my grandfather Sitaram's traditional household, generational tension was never far away. You can imagine how my uncles felt as their father turned a hundred and they entered old age themselves, still waiting to inherit land and gain economic independence. I learned of bitter battles in village families between elders and adult children over land and money. In the final year of my grandfather's life, an angry dispute erupted between him and my uncle with whom he lived. The original cause was unclear: perhaps my uncle had made a business decision without my grandfather; maybe my grandfather wanted to go out and no one in the family would go with him; maybe he liked to sleep with the window open and they liked to sleep with the window closed. Whatever the reason, the argument culminated (depending on who told the story) in Sitaram's either storming out of the house in the dead of night or being locked out. He somehow made it miles away to another relative's house and refused to return for two months.

Global economic development has changed opportunities for the young dramatically. The prosperity of whole countries depends on their willingness to escape the shackles of family expectation and follow their own path—to seek out jobs wherever they might be, do whatever work they want, marry whom they desire. So it was with my father's path from Uti to Athens, Ohio. He left the village first for university in Nagpur and then for professional opportunity in the States. As he became successful, he sent ever larger amounts of money home, helping to build new houses for his father and siblings, bring clean water and telephones to the village, and install irrigation systems that ensured harvests when the rainy seasons were bad. He even built a rural college nearby that he named for his mother. But there was no denying that he had left, and he wasn't going back.

Disturbed though my father was by the way America treated its elderly, the more traditional old age that my grandfather was able to maintain was possible only because my father's siblings had not left home as he had. We think, nostalgically, that we want the kind of old age my grandfather had. But the reason we do not have it is that, in the end, we do not actually want it. The historical pattern is clear: as soon as people got the resources and opportunity to abandon that way of life, they were gone.

* * *

THE FASCINATING THING is that, over time, it doesn't seem that the elderly have been especially sorry to see the children go. Historians find that the elderly of the industrial era did not suffer economically and were not unhappy to be left on their own. Instead, with growing economies, a shift in the pattern of property ownership occurred. As children departed home for opportunities elsewhere, parents who lived long lives found they could rent or even sell their land instead of handing it down. Rising incomes, and then pension systems, enabled more and more people to accumulate savings and property, allowing them to maintain economic control of their lives in old age and freeing them from the need to work until death or total disability. The radical concept of "retirement" started to take shape.


(Continues...)

Excerpted from Being Mortal by Atul Gawande. Copyright © 2014 Atul Gawande. Excerpted by permission of Henry Holt and Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Meet the Author

Atul Gawande is the author of The Checklist Manifesto, Better, and Complications. He is also a MacArthur Fellow, a general surgeon at Brigham and Women's Hospital, a staff writer at The New Yorker, and an assistant professor at Harvard Medical School and the Harvard School of Public Health. He lives with his wife and three children in Newton, Massachusetts. 

Robert Petkoff has won multiple AudioFile Earphones awards for his acclaimed narrations. He was named Best Voice of Fiction & Classics for his reading of The Evolution of Bruno Littlemore by Benjamin Hale. His other narration credits include Oath of Office by Michael Palmer, Gangster Squad by Paul Lieberman, and books by David Foster Wallace.

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 0 ratings. 103 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. 
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.
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.
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.
cloggiedownunder 10 months ago
Being Mortal is the fourth book by American surgeon and author, Atul Gawande. Early on in his book, he tells us :“…the purpose of medical schooling was to teach how to save lives, not how to tend to their demise” and that “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”. But don’t get the wrong idea: this is not a book about dying, so much, as a book that looks at how the latter hours, days, weeks, months or even years of life can be improved. As we get older, and usually frailer (because there is no “…automatic defrailer…” [p44] available to us), we need to rethink where the emphasis should lie: “…our most cruel failure in how we treat the sick and the aged is the failure to recognise that they have priorities beyond merely being safe and living longer…” “We end up with institutions that address any number of societal goals – from freeing up hospital beds to taking burdens off families’ hands to coping with poverty among the elderly – but never the goal that matters to the people who reside in them: how to make life worth living when we’re weak and frail and can’t fend for ourselves”. Gawande’s wife’s grandmother, when institutionalised, remarked: “She felt incarcerated, like she was in prison for being old” Gawande backs up his ideas with plenty of data that is both fascinating and revealing. And while an information dump could be boring, he illustrates all this with the results of studies and anecdotes about real people. It doesn’t get much more personal than the experience of his own father’s decline. “Our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come…” While many practitioners of palliative care will be familiar with what Gawande says, this book should be compulsory reading for most health care professionals. Oncologists, gerontologists, surgeons and intensivists (and their patients!) in particular would benefit from reading this book from cover to cover; those of us with ageing or debilitated family members, or those wanting to plan for their own eventual decline, would also find this book interesting and useful. He concludes: “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?” Recommended.
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 17 days ago
Anonymous 10 months ago
Many times, while reading Being Mortal, I recalled Dr. May Daly's book, Gyn Ecology, in which she details the dehumanization of medicine. Gawande's book focuses on the restoration of whole-person loving care that includes - and does not exclude - the unique individual in end-of-life choices and accommodation. This well-written book, filled with personal narrative, is about clinical medicine's restoration to fullness. Eleanor Cowan, author of : A History of a Pedophile's Wife
Anonymous More than 1 year ago
Anonymous More than 1 year 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 More than 1 year ago
Anonymous More than 1 year ago