I’m a big fan of Atul Gawande’s work, easily the best I’ve read by a medical doctor. His style is effortless, and he manages to find the right balance of technical and non-technical. Being Mortal feels like his most personal work, and I loved it.
While his first three books mostly covered his own experiences through surgical residency and practice, his latest explores a topic he admits up front to knowing very little about. He mentions right away that his medical training included almost nothing about care for the aging, but before long, it’s clear that our entire medical system really doesn’t know what to do with people who are getting older and slowly breaking down.
He is, as most doctors are, most concerned with curing his patients. Find out what’s wrong, go in and fix it, send them on their way. If they come back, then lather, rinse, repeat. They don’t think much about how a particular course of treatment affects their patients’ quality of life. Their job is focused on improving length of life, and in this day and age, the two objectives are often at odds.
Gawande walks us through some specific cases, both professional and personal, and this is what I found most powerful. He writes of his wife’s grandmother, his own grandfather, and finally, his own father as they approach the end of their lives. It’s not light reading, but it was thought-provoking. The key that he discovered was having difficult conversations before it’s too late, both with his own patients and with his loved ones, and it boiled down to two opening questions: What matters most to you? and What scares you?
More and more research points to people living longer on average when their quality of life is better vs. taking on too much aggressive treatment. And even for those who aren’t acutely ill but in long-term care settings because they can no longer take care of themselves, it’s just as important to have the things that matter, even the seemingly small things like being able to lock one’s own door or go to the kitchen in the middle of the night to get a snack.
My uncle died last summer after a near three-year battle against leukemia, which, btw, #FUCKCANCER. His last years were excruciating, and he often expressed regrets that he had gone ahead with the treatments. Hindsight is just the worst, isn’t it? How do you know when to act against every survival instinct, to accept your own mortality and try to make the best of your remaining time? Everybody wants to beat the odds. Few ever do for long, and in the end, death always wins. I hope that I can do something for my older family members and for myself when those inevitable times come. I hope I have the stones to have those difficult conversations.
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