Abstract
Being Mortal: Medicine and What Matters in the End
Atul Gawande
New York: Henry Holt, 2014. 304 pp. $26.00
Atul Gawande is a surgeon at Brigham and Women’s Hospital in Boston, a professor of surgery at Harvard Medical School, and a staff writer for The New Yorker. He is also the son of two physicians who were originally from India. In his fourth book, Being Mortal (a New York Times bestseller), Gwande describes the suffering that occurs as a result of doctors’ inability to talk to patients honestly when life-sustaining treatment turns into futile—and sometime brutal—care. He begins the book by describing how he and his colleagues in medical school learned very little about mortality. They were taught how to save lives, but not how to tend to those whose lives were coming to an end or how to address patients who faced limitations imposed by older age. The goal of the book is to understand “the modern experience of mortality” and medicine’s inability to come to terms with that reality (9).
The book, with an introduction, eight chapters, and an epilogue, includes stories about some of Gawande’s friends and family members who have faced the challenges of older age (such as his wife’s grandmother) or who were diagnosed with a terminal illness (such as his son’s piano teacher and his own father). These stories are told alongside stories about his patients and provide Gwande an opportunity to offer thoughtful reflection on why physicians should learn to assist patients in navigating their lives when medicine can no longer stave off death in any meaningful way. He wants readers to know that extending life-saving treatments that offer little or no hope of success can actually shorten patients’ lives even as it robs them of the opportunity to find meaning, peace, and joy in the years, months, or even weeks or days they have left to live.
Of all the powerful stories Gawande offers, perhaps the most poignant revolves around his father’s struggle with life-threatening cancer. He describes the dramatic difference between one physician, who was too self-important to field his father’s “annoying” questions, another who listened carefully seeking to understand what his father was afraid of and what was important to him, and a third physician who rattled off information too complicated to take in and then declared, “You could be back on the tennis court this summer” (218), a claim that Gawande, his father, and even the doctor, knew to be untrue. With the help of doctors who were interested in establishing reachable goals of care, Gawande’s father was eventually able to take advantage of the life that was his to live. “We witnessed for ourselves,” Gawande writes, “the consequences of living for the best possible day today instead of sacrificing time now for time later” (229).
In addition to describing physicians’ responsibilities for patients who are dying, Gwande draws on the experience of his wife’s grandmother, on gerontologists, and on nursing-care reformers to challenge the present state of nursing care for the elderly with its emphasis on safety above all other aspects of residents’ well-being. Gawande refuses to believe that the system of care we now have is the only option we can make available to older adults. And in light of those who fear that a doctor’s willingness to talk (and write) about mortality “raises the specter of a society readying itself to sacrifice its sick and aged,” Gawande wonders “if the sick and aged are already being sacrificed—victims of our refusal to accept the inexorability of our life cycle” (10). No one wants medicine to give up its increasing ability to extend life, but everyone has a stake in how doctors along with the rest of us are equipped—or completely ill-equipped—to face the end of our lives with courage and honesty while learning to negotiate what matters the most to us as we face life’s end. This isn’t a book about death with dignity or even about how to manage a good death; it is a book about having as good a life as possible until death brings it to an end.
In the last chapter, Gawande discusses two kinds of courage that all of us (not just physicians) should consider: (1) the courage to confront the reality of our mortality while seeking to find the truth about what we fear and what we can hope, and (2) the courage to base our actions on the truth we find. It takes both communal and individual effort to find and cultivate such courage. The church (as well as other religious institutions) could make a valuable contribution to this effort. While this is not a book written specifically for the church, Christian scholars, pastors, and lay people will be enriched by reading it and challenged to think about how to live well even at life’s end and how to think theologically about the human condition of being mortal.