...a valuable contribution to the growing literature on aging, death and dying. It contains unsparing descriptions of bodily aging and the way it often takes us by surprise. Gawande is a gifted storyteller, and there are some stirring, even tear-inducing passages here. The writing can be evocative ... The stories give a dignified voice to older people in the process of losing their independence. We see the world from their perspective, not just those of their physicians and worried family members ... One of his most provocative arguments is that hard-won health and safety reporting requirements for elder care facilities might satisfy family members, but ignore what really matters to the residents in question ... Some of the ideas, however, strain credibility, such as that an increase in people dying in the home in America beginning in the 1990s might reflect a stage when a 'country’s income climbs to the highest levels' ... Gawande offers a succinct discussion of euthanasia at the end of the book ... He is just asking us to commit ourselves to creating better options and making choices with the goal of a purposeful life in mind.
Gawande offers portraits of families struggling with this question, portraits that are attuned to the nuances of intergenerational relationships that make this such a fraught subject ... Gawande's book carefully, gently guides us along the path from the onset of aging and decline and into the wilderness of end-of-life medical care and death. It's already clear that this is an uncomfortable read, one that arouses a sense of indignation and perhaps shame that we've allowed the nursing home industry to define solutions for elder care. But when Gawande dives into his true area of expertise, the medical options offered to the terminally ill, it becomes devastatingly clear how delusional our culture has become about death and dying ... One of the triumphs of Being Mortal is in its language: Because these subjects are so difficult, people all too often invoke treacly platitudes or, in the case of the ludicrous 'death panels' controversy, toxic, fear-driven catch phrases. Gawande's writing is clear and concise and yet gentle and humane. And most important, honest. He finds a way to talk about death and dying safely.
Being Mortal: Medicine and What Matters in the End, Atul Gawande’s masterful exploration of aging, death, and the medical profession’s mishandling of both, is his best and most personal book yet — though a little depressing, until you get to the parakeets ... There’s not much laughter, birdsong, or good news in the rest of Being Mortal, but this book is no lament ... Gawande begins by contrasting the final years of his wife’s grandmother in America with those of his own grandfather in India. These two stories illustrate the central paradox that runs throughout Being Mortal: Sophisticated medical care does not guarantee and often actually prevents a good end of life ... Particularly inspiring are the stories of patients who made hard decisions about balancing their desire to live longer with their desire to live better.
In a moving series of reflections, he reveals just how terrible doctors are at telling patients when treatments are unlikely to work, and how hopeless they are at estimating how much time their terminally ill patients have left ... The intrusion of commercialised medicine, and the elevation of the interests of insurance companies over those of patients, can complicate these issues considerably, but Gawande remains clear-sighted through the muddle of anxieties, conflicting emotions and vested interests ... When time becomes short, Gawande has the presence of mind to ask his father: 'How much are you willing to go through just to have a chance of living longer?' The answer helps guide his father to a relatively peaceful death in the arms of his family, as opposed to a technologised end on an intensive care unit. The message resounding through Being Mortal is that our lives have narrative – we all want to be the authors of our own stories, and in stories endings matter.
He divides his book into eight beautifully written chapters that follow the trajectory from independence to death. Being Mortal, the most personal book he has written, ends with the long dying of his own father ... In his most powerful chapter, called 'Letting Go,' a version of which was published in The New Yorker in 2010, Gawande deals with the awful dilemma of deciding when to stop trying to prolong life, or in his words, 'When should we try to fix and when should we not?' ... Gawande has provided us with a moving and clear-eyed look at aging and death in our society, and at the harms we do in turning it into a medical problem, rather than a human one. I wish he had spent more time on what could be done to make things better (parakeets and dogs aren’t enough), but he has certainly shown us what is wrong. Narrowing the lives of the aged down to mere existence in institutions and submitting the dying to the full panoply of procedures that modern medicine has to offer cause enormous, unnecessary suffering. There is no way, of course, to make old age and all its infirmities disappear; it is what life deals us. But what Gawande shows us in this admirable book is that we could handle it a lot better.
...an eye-opening and convicting look into medicine and what lies ahead for each of us in our life-extending world of medical care. Whether a member of the aging population or a child of aging parents, this book will make you ask questions about how you want to direct medical care for your future and those of your family ... This isn’t a happy read, as death marks many of his patient’s stories. But, it will offer you a chance to reflect on what is truly important to you in the rest of your life. Whether you leave this Earth without any notice or after struggling through an illness, Gawande wants to be sure you have made choices, shared them with those you love, and lived each day to its fullest potential.
...Being Mortal will send a shiver through anyone who would like to face old age with dignity intact and their wishes honored ... What elevates Being Mortal beyond being a mere a litany of complaints about how hospitals and nursing homes treat people is Gawande’s reporting on different approaches —– and the positive results of humane care ... These patients are much more than nameless case studies. Gawande’s story of his proud father, also a physician, and how he navigates his last years, gives Being Mortal a special poignancy. The author shares doubts about his father’s decisions, recounts family debates about what to do and expresses his deep frustrations with medical professionals who don’t listen to a patient’s wishes ... This book is an eloquent, heartfelt cry for change. We can only hope it opens a few eyes.
Gawande...doesn't even mention assisted suicide until the final chapter, and then only as a brief aside (he's not particularly enthusiastic about it). Instead, his primary concern is how we spend the time allotted to us, whether it's hours, weeks, or even years, once it becomes clear the sands have almost run out ... The central message of the book is that we need to talk, early and often, about what end-of-life treatments and trade-offs we consider desirable or tolerable ... The most poignant storytelling in the book deals with Gawande's own father, who also develops a spinal tumour ... widespread and lasting change in our attitudes to being mortal is possible. Maybe Gawande, who wields outsized cultural influence, can trigger it.
Dr. Gawande’s book is not of the kind that some doctors write, reminding us how grim the fact of death can be. Rather, Dr. Gawande shows how patients in the terminal phase of their illness can maintain important qualities of life with medico-surgical assistance. Being Mortal doesn’t gloss over what awaits us all, but it fixes our attention on the ways in which a patient’s wishes might be fulfilled—such as the wish for a peaceful, clear-headed valediction among loved ones. As Dr. Gawande chronicles, this effort requires thought and determination on the part of the doctor, the patient and members of the family ... By making a forceful case for palliative care and hospice services—with their capacity to sustain life’s quality out to the end—Being Mortal provides a response to the presumptions of despair that fuel the euthanasia movement.
Gawande points out that we have medicalised the care of the aged and terminally ill to the point where doctors often forget the wellbeing of the patient in their anxiety to do everything medically possible to prolong life and prioritise safety ... A few inspirational developments for the elderly are discussed ... This humane and beautifully written book is a manifesto that could radically improve the lives of the aged and terminally ill.
...a compelling account of modern medicine’s failures to deal humanely and wisely with aging and dying ... Nothing short of a manifesto, Gawande’s book should be on the shelf of every health care professional as well as required reading for anyone—which is to say, most of us—facing the prospect of providing for an aging family member.
We need people of such outstanding intelligence and compassion to consider the ever-growing problems associated with our ageing population ... The book proposes some attractive solutions, notably various kinds of assisted living. How viable such schemes are to anyone but the well-off is another question ... The elephant in the room is dementia ... They and the people who look after them are stuck in a ghastly limbo and even a mind as fine as Atul Gawande’s cannot find a way out. He is, after all, a doctor: he likes problems that can be solved. In Being Mortal he accepts that he does not have all the answers, but calls for more imagination and invention in the care of the old and the dying. This is a truly important book.
Through both solid research and brilliant storytelling, Gawande invites us to sit at the bedsides of his former patients, friends and family members whose final days were fraught with more pain and suffering, both emotional and physical, than might have otherwise been necessary ... In vivid and heart-wrenching detail, he describes the final days of patients who were in such denial of their imminent deaths that they, or their families, demand futile life-saving measures ... Gawande is thoughtful in his assessment of myriad economic, political and social structures that stand in the way of supporting individuals who wish to live productively in their twilight years — and who hope for a 'good death' when it is their time ... While he offers suggestions for change, his prescriptions are at times embedded in the narratives in such a way that they get lost in the pathos. Because of this, some readers may come away with the idea that all hope is lost ... a checklist of the concrete steps a person might take to begin these difficult discussions with one’s doctors, caregivers and family members would have been a helpful addition to Gawande’s new book ... Gawande’s urgent and needed call to action is most appreciated.
...a cleareyed look at aging and death in 21st-century America ... a timely account of how modern Americans cope with decline and mortality ... Rather than simply inform patients about their options or tell them what to do, some doctors, including the author, are choosing to offer the guidance that helps patients make their own decisions regarding treatment options and outcomes ... A sensitive, intelligent and heartfelt examination of the processes of aging and dying.
