Atul Gawande

A prominent surgeon argues against modern medical practices that extend life at the expense of quality of life while isolating the dying, outlining suggestions for freer, more fulfilling approaches to death that enable more dignified and comfortable choices.

Medicine and What Matters in the End

Being Mortal

Julia <3

Most doctors treat disease and figure that the rest will take care of itself. And if it doesn'tif a patient is becoming infirmn and heading toward a nursing home -well, that isn't really a medical problem, is it? To a geriatrician, though, it is a medical problem. People can't stop the aging of their bodies and minds, but there are ways to make it more manageable and to avert at least somne of the worst effects. 

Even our brains shrink: at the age of thirty, the brain is a three-pound organ that barely fits inside the skull; by our seventies, gray-matter loss leaves almost an inch of spare room. That's why elderly people like my grand- father are so much more prone to cerebral bleeding after a blow to the head-the brain actually rattles around inside. 

Modernization did not demote the elderly. It demoted the family. It gave people -the young and the old-a way of life with more liberty and control, including the liberty to be less beholden to other generations. The veneration of elders may be gone, but not because it has been replaced by veneration of youth. It's been replaced by veneration of the independent self. 

Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers. 

Daniel Bower

You live longer only when you stop trying to live longer.

Pratik M

I started reading Being Mortal nearly a year ago and somehow never got around to finishing it. It’s admittedly a difficult read in the sense that it can be overwhelming at times. I finally finished it last night. 

The premise focuses on the quality of life rather than the length of life and more specifically, the manner in which you choose to pass away. Medical science has advanced to such a degree that humans can be kept alive for a much longer time than you would imagine. But no one has stopped to ask the question of whether we should. Or as in Amitabh’s immortal (no pun intended) words, yeh jeena bhi koi jeena hai. Gawande cites several examples from his professional and personal life that focuses on the individual’s choice on care and ultimately, way to die. The Republicans’ favorite chant ‘death panels’ actually referred to the end of life counseling that doctors offered their patients. It’s the ultimate decision you can take for your life.

You do not choose to be born in this world and as of today, most laws even prevent you from actively choosing to die but at least you can choose the way you die when and only when you’re diagnosed to. The DNR is the most commonly known legal process in our pop culture and medical professionals are taught to honor it just as they’re taught to honor the first do no harm principle. Others like hospice care are fraught with emotions that you may not be fighting back hard enough. But after a while, it’s useless fighting nature.

Being Mortal will not only make you aware of your mortality but actually prepare you for it. I say that in the most humble and optimistic way. You aren’t immortal. You’re going to die. You’re born in perhaps one or two ways but you can die in umpteen different and uncharacteristic ways. The worst I believe, waiting to die which can be a long and painful process not only for the person but also for their loved ones. Modern medicine can perhaps keep you alive for as long as it is possible today but it’s entirely within your rights and choice to decide when enough is enough.

Heartbreaking and real and everything. It occurred to me halfway through that these are the kinds of self-help books we need, on top of the other stuff. It reminded me to approach my aging family with kindness and forgiveness and as much love as I can. I highly recommend to anyone and everyone. 

Emma

Timeo Williams

Excellent book and especially relevant to my personal situation, as I have the opportunity to live close by my grandparents. I've seen them age and they've done quite well, luckily. But my situation is unique compared to the majority of grandparents living in assisted living centers and nursing homes. 

Gawande writes about these developments, his background and cultural upbringing and the pros and cons of family caring for the elderly to elders living in very "safe"/privatized environments. 

This book had gotten me to start thinking about retirement and old age in a different light and also has me pondering how I should die - in an engineering perspective. What are the trade-offs by which I consider acceptable? If I can no longer read, understand what's going on around me, help others - is it worth going through additional rounds of chemotherapy to never return to those activities? Definitely topics to consider.

Hannah Yoon

Gawande is a powerful and gentle storyteller. Definitely a life-changing book. I listened to the audiobook and felt like I was listening to a podcast. As much as I'd like to avoid the topic of death and aging, it's an inevitable one that I know I'll have to dive into soon. The ideas he brings up should be ones we discuss often, however, it's obvious we're still not there yet as it is seen in the current state of nursing homes and the other options there are for those that are dying and sick. This book will follow me as I navigate into the territory of mortality, sickness, death and aging with my parents and my own life.

so refreshing and has a journalistic feel to it- from personal experiences to interviews to articles. really love gawande’s people-first approach and it’s a must read for anyone in healthcare

vania

Aamna

Okay we all really need to figure our shit out especially how to make sure that we don't fall EVER.

Rohit Arondekar

People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and escape a warehouse oblivion that few really want.

Being Mortal is a call to humanise the brutally capitalistic medical industry that has perfected the art of rationalised cruelty and lost sight of the patients well being. Beautifully written, thought-provoking, well researched and drawing on personal experiences of the author—this is a must-read book.

Obada Mu

"Old age is a continuous series of losses." Atul Gawande

Really insightful and - for me - actionable. Recommended for all who has old relatives, or isn't young themselves, or whose who encountered with serious illness. 

Oksana Rudenko

Named a Best Book of the Year by The Washington Post Apple iBooks The New York Times Book Review NPR Amazon Chicago Tribune Medicine has triumphed in modern times, transforming the dangers of childbirth, injury, and disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should. Through eye-opening research and gripping stories of his own patients and family, Gawande reveals the suffering this dynamic has produced. Nursing homes, devoted above all to safety, battle with residents over the food they are allowed to eat and the choices they are allowed to make. Doctors, uncomfortable discussing patients' anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them. In his bestselling books, Atul Gawande, a practicing surgeon, has fearlessly revealed the struggles of his profession. Now he examines its ultimate limitations and failures-in his own practices as well as others'-as life draws to a close. Riveting, honest, and humane, Being Mortal shows how the ultimate goal is not a good death but a good life-all the way to the very end.

Sierra Nguyen

There are a lot of moments from this book that make me pause and really think about what it means to live. I learn from this book that although modern medicine has the power to prolong one's life better than ever before, it can't always guarantee that the extended life that it's given to people is the life they want to live. Toward the end of one's life, there is so much more than they may want to do than just to "be safe" or to "survive." The lessons from this book will help anyone who may be taking care of an elderly person or a terminally ill patient, as what we often think is best for them may not be what they truly want, after all. 

None of us mortal people can live forever, so let's give one another a chance to lead the life we really want.

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering. Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Medicine and what Matters in the End

Pratul

I can't think of anyone who shouldn't read this book. 

A difficult read, yes, but what an incredible account of life through death. It raises many pertinent questions and offers some (valuable) responses to them, and left me with a lot of thinking material.

Dana Kraft

Adds depth and specificity to the truism that the healthcare industry is really good at identifying and addressing specific diseases. The presumption is that this will give people a better quality of life. This assumption can break down pretty quickly as we age, but medical professionals and the industry in general haven't caught up with this reality. Best takeaway is the questions to ask someone facing a difficult decision.
1. What is your understanding of your condition and its consequences?
2. What are your biggest fears and concerns?
3. What are your goals with this?
3. What tradeoffs are you willing to make to have more time at a lower quality of life? What tradeoffs are you not willing to make?

Jeet Jhaveri

While we live, we should think about death, particularly how we want to die and how we should be treated if suffered with near death medical fatalities.
The second thing this book talks about his how the medical community and society in general needs to view the objective of treatment being not just to cure but to cure/treat/repair keeping in mind the well-being of the opposite human being and not just an extension of survival of life that's not "full of life".

Caitlyn Baldwin

I thought this piece was very thought provoking. Given the increasing average life span I think that our more recent generations have a lot to face with such a large aging population. Dr. Gawande especially addresses compassionate care for the elderly, palliative care, and his views on "dying with dignity". I've read materials addressing similar themes by mostly ethicists so it was interesting to hear the perspective of a physician.

Kat A

Losing my independence and mobility in old age, and having to live out the rest of my days in a depressing and underfunded care facility, is one of my biggest fears. 

This books tackles the questions we need to ask ourselves and our loved ones before that stage of life comes. The more honest and specific you can be, the better. 

This book discusses questions like:

How much intervention is too much, and when is it doing more harm than good? 

Why does our society still see death as a medical issue and not an issue of well being? 

Fascinating read. 10/10 stars.

For most of human history, death was a common, ever-present possibility. It didn't matter whether you were five or fifty - every day was a roll of the dice. But now, as medical advances push the boundaries of survival further each year, we have become increasingly detached from the reality of being mortal. So here is a book about the modern experience of mortality - about what it's like to get old and die, how medicine has changed this and how it hasn't, where our ideas about death have gone wrong. With his trademark mix of perceptiveness and sensitivity, Atul Gawande outlines a story that crosses the globe, as he examines his experiences as a surgeon and those of his patients and family, and learns to accept the limits of what he can do. Never before has aging been such an important topic. The systems that we have put in place to manage our mortality are manifestly failing; but, as Gawande reveals, it doesn't have to be this way. The ultimate goal, after all, is not a good death, but a good life - all the way to the very end. Published in partnership with the Wellcome Collection. WELLCOME COLLECTION Wellcome Collection is a free museum and library that aims to challenge how we think and feel about health. Inspired by the medical objects and curiosities collected by Henry Wellcome, it connects science, medicine, life and art. Wellcome Collection exhibitions, events and books explore a diverse range of subjects, including consciousness, forensic medicine, emotions, sexology, identity and death. Wellcome Collection is part of Wellcome, a global charitable foundation that exists to improve health for everyone by helping great ideas to thrive, funding over 14,000 researchers and projects in more than 70 countries. wellcomecollection.org

Illness, Medicine and What Matters in the End

Cindy Lieberman

This should be required reading for all adults over 30.

Melody Izard

We grow old and eventually die. There is a whole industry waiting for our money and to suck the life out of our final days. Why can't we die with dignity and with love and not spend our final days chasing cures that don't exist? Atul Gawande offers some options.

Diana Platgalve

** spoiler alert **
           Very interesting read on how people reach the final stages of their life and the role of medical personal and assistance in it. The book is divided in two parts: one focusing on dying of old age, other- dying of terminal illness with no cure. 
For the first part I enjoyed the references made to various studies and organisations that focused on elderly care. When you get old, it is a constant battle of losing. You lose your loved ones, your friends, your hobbies, your own abilities. From reading the text, you feel how devastating from psychological perspective it can be when you lose your own independence, and how hard medical personal sometimes have to work, to ease the devastation and provide a new meaning for elderly. 
Second part includes hard conversations when someone faces something incurable and a little discussion on assisted death. Again I enjoyed many perspectives on hard conversations. The ones he had as a doctor himself, and the ones he had as a family member of someone who dealt with terminal illness. 
It is an emotional read, as you can follow so many people facing their last days and the passing of the authors father. This book provides so much information and perspectives, that I recommend to read for everyone. Because we all have to deal with being mortal.

Michelle Xu

I try to make a point of writing a review immediately or a few days after I finish reading a book so that it’s still fresh on my mind when I do write. But I got lazy and totally forgot to write one… So here is a delayed and not as comprehensive review:

I started this book about 2 months ago during finals week. I had to force myself to put it down so I could study. Finally, I finished the whole book on a long airplane ride followed by a subsequent car ride. That whole time I tried to hide my face from people because I didn't want them seeing me cry...

I rarely rarely rarely read nonfiction. I can’t even remember the last time I ever read a nonfiction book that wasn’t forced upon me by an English class. I always assumed nonfiction meant boring and uncreative or lacking in elegant writing. Boy was I wrong. This book has definitely inspired me to look more into nonfiction in the future.

No matter what, I strongly urge anyone and everyone to read this book. While the book is US-centric, I do think anyone can relate and sympathize with the ordeals of aging and end-of-life care.

So full disclosure: I’m a Health Care Management and Policy major. So this type of book is exactly the type of nonfiction book I would actually read. Everything mentioned in this book made me nod and think about what I’ve learned in class. I already knew that the American health system and mindset was a little fucked up. I knew most of the statistics Gawande mentioned in his book. But what surprised me most was the emotion behind this book. All the hundreds of interviews conducted and written down on paper by Gawande perfectly pulled the themes and issues together.

I would split the book into two parts. The first half is about aging and elderly care. It is filled with stories about people who don’t really have a specific illness, but rather a cocktail of chronic diseases like diabetes, hypertension, a history of heart attacks, hip fractures, weak knees, memory loss, etc. We walked through the lives of multiple families and their often-unhappy endings. Along they way, we learn of the strides taken in nursing home and assisted living reform. While Gawande ends this first topic on a fairly optimistic note if care reform, the whole shrinking area of the geriatric field is worrisome and the lax regulations on nursing homes make me worried about what would happen when my grandparents got too old to live on their own.

The second half is about terminal illnesses and end-of-life care. Again, this latter half is filled with more stories and anecdotes from people Gawande had interviewed. What set this apart from the first half, was the fact that it was so much more personal. Gawande weaves in the heartbreaking story of his own father’s battle with spinal cancer and the downward spiral that resulted from the disease. There are many more heart wrenching anecdotes within the second half, but I think the pain, confusion, and distress from Gawande’s personal story shone through.

One aspect that I thoroughly appreciated was Gawande’s admittance of his own shortcomings as a doctor and his struggle with defining and adjusting what a doctor’s role is in society. It’s no longer to fix but to promote the patient’s highest well-being—and that doesn’t always mean fight a terminal disease to the end. He also admits to struggling with talking to patients about end-of-life care. You never want to tell someone that they’re dying. You want to be the bringer of hope and possibilities… not death. But then there’s a good way and bad way to talk about death. Gawande’s struggle and then practice with talking about end-of-life care was definitely one of my favorite parts. The book does a good job humanizing doctors. You get to see that there are some doctors who really do what they do because of their dedication to patients, then there are others who are either too uncomfortable, too busy, or too haughty to deal with the emotional side of patient care. (My hope is that those doctors will snap out of it and work along with health administrators towards patient-centered care).

By the end of this book, I don’t think I have any negative things to say about it. JUST READ IT!

Julie Berman

Brian Alderman

Wow. Besides being beautifully written, the data this book explains and the case it lays out for our healthcare system is compelling and necessary!

Lucas Coelho

“All we ask is to be allowed to remain the writers of our own story. That story is ever changing. Over the course of our lives, we may encounter unimaginable difficulties. Our concerns and desires may shift. But whatever happens, we want to retain the freedom to shape our lives in ways consistent with our character and loyalties.” 

“Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.”

Luca Conti

 Bruna Acioly Leão

As a doctor and someone who works (and enjoys working) with elderly people, I really related and agreed to what this book had to say.

Being Mortal Medicine and What Matters in the End

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