Being Mortal

This has been the most enlightening, heartwarming and sobering book I've ever read. Being at what I hope is not quite my mid-life (44y/o) I've been thinking more about my mortality in the last couple of years - however this has reinforced some of my thinking about making the most of the time we have, but also opened my eyes up to the fact a lot of that is out of our control and the sooner we have the 'hard conversations' with both our loved ones, and ourselves, the better it is to have such clarity.

I also now realise that I need to have the conversation with my parents who are fortunately still alive and in relatively good health for their ages (father/80, mother/72). And then subsequently to have with my wife and children before things get too far along.

This really is a must read for everyone...because we are all going to end up here eventually, with no exceptions.

 I bet that if you’re friends with a doctor or a police officer you are either a doctor or a police officer yourself.
 Both occupations give their practitioners intimate views to dramatic times in the lives of others. This too often leads them to having a clubby, supercilious view of what they’d call “civilians,” or “ordinary people” that makes much of what they’ve written come off as condescending, even smug.
 Atul Gawande avoids that In Being Mortal—Medicine and What Matters in the End. Not that you don’t know who and what he is, which is a Harvard Medical School professor and Brigham and Women’s Hospital surgeon who writes best selling books and articles for The New Yorker, but in this book Gawande freely shares his shortcomings and what he learns along his way through the mess of the American healthcare system’s handling of its citizens last days.
 Gawande has the rare talent for writing well and knowing how to research his subject objectively. Being Mortal has an introduction, eight chapters, and an epilogue. To me, the beginning of the epilogue sounds like it would have made a good introduction:

Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and the cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be.

In the end, people don’t view their life as merely the average of all of its moments—which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people’s minute-by-minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life may be empty. A seemingly difficult life may be be devoted to a great cause. We have purposes larger than ourselves.

I find the discussion of end of life matters fascinating.  I've lost track of how many times I've been asked if I'm not scared about what will happen when I'm old since I've chosen not to have children.  That never seemed like a good enough reason to have kids since there is no guarantee that your children will outlive you or be physically/mentally able to take care of you in your old age.

Regardless of your number of offspring, I think everyone is nervous about what will happen with age.  No one wants to lose their independence.  That is the point of this book.  The author looks at several programs that aim to let people continue to live a good life as they age and then have a good death.

I was encouraged by reading about all kinds of different ways that people are rethinking elder care.  I have a dream of a community of cottages for old introverts where you check in once a day so everyone knows that you are still alive and there is a movie playing every night in case you want a group activity where you don't have to talk to anyone.  No one has quite made that yet but there were some that I wouldn't mind.

One of the major concerns in allowing a more independent old age is safety.  If you want people to be totally safe, then you can't let them walk around and make (possibly poor) decisions for themselves.  Children of elderly people tend to value their safety over their happiness.  This leads them to make decisions about care that take away options from the parent.

Has anyone made progress with good deaths?  I still think that the way humans approach death is pretty horrific.  I'm coming to this discussion from my perspective as a veterinarian.  We're all about palliative care until there is a poor quality of life and then euthanasia so there is no suffering.  The author discusses increasing access to hospice care earlier in the patient's care to decrease extreme medical interventions that are required of hospitals but don't ultimately aid the patient.  That's good but then every story of a "good" death he cites ends with several days of the patient being on all kinds of pain medication so they drift in and out of consciousness.  They may not be in pain but what is the point?  They are past communication.  The families are holding vigils waiting for them to let go.  It seems to me that an overdose at this point is so much kinder.

I hear this all the time during euthanasias.  People start to talk about their relatives' deaths and how they wish they could have helped them in this way so they didn't have those last few days.  I understand slippery slope arguments but it just seems like common sense to me.

The author also discussed different personality types of doctors and how they help and hurt decision making.  There are authoritarians who tell the patient what to do without much discussion.  There are doctors who give the patient all their options and let them decide what to do.  I'm the latter one.  We were trained to do this in school.  It can confuse clients because they get overwhelmed.  They then counter with, "What would you do?"  We aren't supposed to answer that question.  It isn't a fair one anyway. We aren't in the same situation.  I could do things at home that you might not be able to.  I might tolerate inconveniences more or less than you do.  The author talks about how he learned to give more opinions about how different choices might affect their lives.  I've started to do this too some.  I think it has helped some people.

He also recommends having end of life discussions with your family members before decisions need to be made.  Then if you are in an emergency situation where you can't talk to them about it, you know what to do.
What would be your ideal way to live out your last few years?
 This review was originally posted on Based On A True Story