7 Things I Learned from Atul Gawande’s Being Mortal

Sometimes the right book comes your way at exactly the right time. I’ve always loved Atul Gawande’s writing—with his compassion and common sense, he’s the kind of doctor you pray to get at the hospital—and in Being Mortal: Medicine and What Matters in the End he tackles a very tough subject: old age. Having recently moved my father from my house to assisted living, I felt as if this book was written just for me. But really, Gawande’s interviews with seniors, families, and medical staff are pertinent to all of us because one day, like it or not, we will face these same hard choices. Here are 7 things I learned from Gawande’s book:
1. Independent living is directly related to having children—particularly daughters
There’s an old saying that goes, “A son’s a son till he takes a wife, but a daughter’s a daughter for all her life.” Research bears this out. Daughters or daughters-in-law are overwhelmingly more likely to make the sacrifices caretaking requires, whether that means stopping by a relative’s home once a week to drop off groceries, or quitting work and moving the relative into their own home. Seniors without children almost always end up in group facilities.
2. Nursing homes were never intended as permanent housing
Back in the 1950s, when the government began building nursing homes, it was to clear out hospital beds, hence the name “nursing” home. Patients were expected to recover and leave. Seniors only started being admitted by default, because, while medical science keeps extending human life, our society has few places for the elderly to go.
3. Who should be thanked for assisted living
The next time you hear someone moaning that one person can’t change the world, tell them about Keren Brown Wilson. When Wilson was a teenager, her mother suffered a debilitating stroke and had to enter a nursing home. She hated it, begging “Take me home” at the end of every visit. What her mother wanted, Wilson says, was a place where she could “lock her door, control her heat…where she would be a person living in an apartment instead of a patient in a bed.” Years later, after earning her degree in social policy, Wilson began drawing up blueprints for just such a place, and the first assisted living facility opened in 1983. Now they’re all over the world—including Philadelphia, where my own father happily controls his heat, keeping his room subtropical.
4. People need to be needed
That doesn’t change just because we get older. Test after test shows that when cats, dogs, and plants are part of a community and seniors are responsible for their care—say, watering a cactus every day—those seniors live longer and need less medication. In one striking example, a doctor reports that after her staff moved several resident dogs into the building, “People who had been completely withdrawn and nonambulatory started coming to the nurse’s station and saying, ‘I’ll take the dog for a walk.’”
5. Institutions tend to focus on measurable results
This was eye-opening for me and actually changed the way I treat my father. Gawande points out that although we may know people are more than bodies (see #4), bodily safety is easy to measure, while quality of life is not. As a result, most facilities value safety over autonomy. But what do seniors value? Autonomy. I read this and it was like a light bulb going off: I asked the staff at my father’s residence to stop chasing him down the halls and insisting he use his walker. The fact is, Dad walks just fine, and he hates that walker.
6. There are worse things than dying
How would you rather leave this world: at home in your bed, or hooked up to a feeding tube in a hospital? Dumb question, right? The reason so many people die the second way is that denial runs deep. Not only do patients cling to false hope, doctors do too, often recommending painful treatments long after death is inevitable. Gawande gives some sobering statistics on how many doctors misjudge the time patients have left (the better they know the patient, the more they overestimate). If you want to die peacefully at home, you have to be able to say “Enough.”
7. We’re all in this together
One of the book’s most moving moments comes when Gawande is interviewing a 94-year-old man named Lou and finds himself inspired. He writes, “We’d been talking…for almost two hours when it struck me that, for the first time I can remember, I did not fear reaching his phase of life.” Amen to that.
Being Mortal is available now.