Book 52 – What Matters in the End

“A colleague once told her, Wilson said, ‘We want autonomy for ourselves and safety for those we love.’ That remains the main problem and paradox for the frail.”

The above quote sums up beautifully much of what Dr. Gawande discusses in this really lovely, interesting and motivating book. Being Mortal focuses on how modern medicine has failed us in that it can keep people alive much longer than it used to, but often at a very serious cost. His focus is primarily on the elderly, but he also includes the seriously, terminally ill in this exploration.

Think about the above quote. We all want to do what we want – to have the freedom to decide when we will get up in the morning, what we will eat, and who we will spend time with. But, when it comes to our loved ones, it seems that so often what we most want is for them to be safe. It is that concern that has led us to do things like put people into nursing homes to keep them safe from falls, even though they are much more miserable. As long as they are safe, that’s all that matters. But Dr. Gawande makes the very compelling argument that the safety isn’t the primary concern, or shouldn’t be. Allowing people to live meaningful lives, whatever the person’s own definition, should be our concern as people age or experience the end stages of a terminal illness.

The book does a great job of illustrating how doctors really shy away from having the frank conversations with their seriously ill patients. They provide information, but that information is often based on what to do to lengthen life, not improve the quality of it. Taking a page from the palliative care / hospice movement, Dr. Gawande advocates for asking the hard questions, like what do the patients fear most, what is the quality of life they’d be willing to tolerate, and similar questions, to really get at the heart of their concern.

Dr. Gawande also looks at how, especially with the elderly, we focus too much on keeping them safe as opposed to happy. He provides the back story on the nation’s first true assisted living facility, where residents were allowed to do things like lock their doors. Yes, they might fall, but the staff was dedicated to providing whatever support services were necessary to allow these residents to keep as much independence as possible. It is amazing when you really think about how much we focus on things like fall prevention (which is important, obviously), but not on really figuring out ways to prevent the falls WHILE allowing people access to the things in their lives that matter, like deciding when to get out of bed in the morning.

I strongly recommend this book, especially for those who have parents who are elderly, or for those who care about the quality of life of seriously ill people. It asks us to reframe our thinking, and really consider what it is that we value, and how we would want others to take that into consideration as we got older or sicker.

And with that, I complete my second Cannonball Read. I’ve put together a wrap-up post over on my own blog: Cannonball Read 6: My Year in Books.