Book Review — Being Mortal by Atul Gawande
During the week, I completed Atul Gawande’s book “Being Mortal: Medicine and What Matters in the End.” Gawande is an eminent American surgeon and writer. As a public health expert, he was named a member of President-elect Joe Biden’s COVID-19 Advisory Board in 2020.
If you contemplate aging before death or acknowledge the inevitability of death in the future, if you have loved ones who may face death, or if you are a health professional who interacts with patients, this book, published in 2015, is a must-read.
At the core of this book is the reminder that we are human, not immortal, and that dying is a natural, inevitable consequence of living, something we tend to forget. To that end, how do we prepare for this inevitability? How should we approach life so that by the time we are bedridden and can no longer do the things we love, we retain our sense of self?
The reality is that while modern scientific capability has profoundly altered the course of human life, health care professionals have proved alarmingly unprepared for it. The subjects of the Roman Empire had an average life expectancy of twenty-eight years. Today, even in developing countries, the average life expectancy is twice that. In developed countries, living to 70+ years is the norm, not the exception. Therefore, instead of completely relying on poorly prepared professionals, how does the average person prepare for the possibility of long life and the inevitability of old age?
But first, it’s important to remind ourselves that some of the things we think we would never experience would likely occur if we live long enough. With age, our body wears away. The blood supply to the pulp and the roots of the teeth will waste away, and the flow of saliva will diminish. Arthritis, tremors, and small strokes, for example, make it difficult to brush and floss, and because nerves become less sensitive with age, people may not realize that they have cavity and gum problems until it’s too late.
What about our hair? We will run out of the pigment cells that give hair its color, turning it grey. Even experienced geriatricians are caught off-guard by the developments in their bodies. A story in the book was about one whose skin dried out, his sense of smell diminished, his night vision became poor, and he tired easily.
“I can’t think as clearly as I used to. I used to be able to read the New York Times in half an hour. Now it takes me an hour and a half. If I go back and look at what I’ve read, I recognize that I went through it, but sometimes I don’t really remember it.”
Did you know that as you get older, the lordosis of your spine tips your head forward? This means that when you look straight ahead, it’s like looking up at the ceiling for anyone else. So, for the elderly, the best way to eat is by looking down. Otherwise, they choke. How about that for growing old?
“Old age is not a battle; it’s a massacre.”
Which is why I will never understand why we have so many presidents and heads of state who are septuagenarians (70+) and octogenarians (80+). Don’t they have people who care about them in their friends and family circle? Let’s leave their diminished ability to lead their country; why would they hasten their death with such a workload? An 86-year-old man was convicted of manslaughter after he confused the accelerator with the brake pedal and plowed his car into a crowd of shoppers. Ten people were killed, and more than sixty were injured.
As I shared excerpts from the book, I read some Nigerians talking about how the system is failing the elderly in the developed world. “Why are they abandoned? Why can’t they learn from us how we take care of the elderly?” I could only shake my head. Not only is our average life expectancy 52 years, but most also decline healthcare due to the lack of faith in the healthcare sector and, more importantly, low disposable income. As the examples he gave from South Africa show, as a country’s economy improves and incomes rise, people begin to turn to healthcare systems, often dying in hospitals.
The last stages of people’s lives are often not lived on their own terms. Their actual choices are impaired, and decisions are made without full knowledge or understanding. This theme is part of the main thrust of the book.
The author convinces the reader not to allow the medical establishment to completely monopolize the business of dying; their dying. This conviction came from his experience as a surgeon who saw himself as informative — telling the patient the facts and figures and leaving the rest up to them. He says the best type of doctor is interpretive, who takes on the role of helping the patients determine what they want. Interpretive doctors ask, “What is most important to you? What are your worries? How will you not like to go finally?” Then, when they know your answers, they tell you about the red pill and the blue pill and which one would most help you achieve your priorities.
There are several examples of people deciding to forgo surgery when they realize that even though they would survive, they would be unable to enjoy their food or watch their favourite sports teams on television. For some, what is the point of being plugged into a ventilator when they could spend the rest of their lives around their grandkids and loved ones? These are often decisions that patients on their last leg are unable to make because they had not thought about them ahead of time.
“Being Mortal” is not merely a book about death; it is a celebration of life and a call to action for a more compassionate and holistic approach to aging and dying. Gawande challenges us to rethink the role of medicine in our lives and advocates for a paradigm shift towards patient-centered care that prioritizes quality of life over mere prolongation.
It’s a poignant reminder that death is not the end, but a natural part of the human experience — and how we choose to face it defines the essence of our humanity. This book still leaves you with many questions — like, how do we learn to ask better questions about our aging? — but Atul Gawande’s wisdom and empathy shine through every page, leaving readers with a renewed perspective on what it means to live — and d!e — with dignity and purpose.
