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Being Mortal: Medicine and What Matters in the End

por Atul Gawande

Outros autores: Ver a secção outros autores.

MembrosCríticasPopularidadeAvaliação médiaMenções
5,1682812,049 (4.46)551
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.… (mais)
  1. 20
    Final Exam: A Surgeon's Reflections on Mortality por Pauline W. Chen (BookshelfMonstrosity)
    BookshelfMonstrosity: Written by experienced and dedicated physicians, these compelling books question American health care's emphasis on management and technique to the detriment of human relationships between doctors and patients, especially when the patient's mortality is an important consideration.… (mais)
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This book should be required reading for anyone with aging parents. Who am I kidding? Everyone needs to read this because all of us will face these decisions someday for ourselves or for someone we love.

The book talks about death with dignity. What makes life worth living when your body is at the edge of failure? How much medicine is too much? How can we do the right thing to make care for the elderly better in assisted living homes?

I read this book a week after my Mother passed away. I feel comforted by the book because it supports the decisions that were made at the very end of her life but it makes me feel terrible about my own lack of interest in her life while she was living in assisted living.

Very readable despite the subject matter. ( )
  hmonkeyreads | Jan 25, 2024 |
An important book, but gut wrenching to read. I wonder how many important conversations with loved ones will be started by people who read it. How much are you willing to suffer now for a chance at more time? How do you choose between options that are all terrifying? Who can you count on to decide for you when you can't decide for yourself? I hope all med students read it. One of the few light moments for me was how much doctors don't want to treat "Old Crocks" as we oldsters are known. I'm going to make a real effort not to seem vague and cranky next time I talk to a physician. ( )
  dhenn31 | Jan 24, 2024 |
Several years ago, when my husband and I spelled out our medical directives, I emphatically voiced to him that, if I became unable to communicate or move, I needed to have 2 conditions.
1. I needed to be near a window that opened to a cool breeze.
2. I needed to have a view of trees.

This books helps us understand why there is so so much more that needs to be included in that conversation.

If we are indeed the authors of our own story, we need to spend time and effort to craft the final chapter now. There won't be any opportunity for postscripts. ( )
  jemisonreads | Jan 22, 2024 |
I found it a difficult read with too many anecdotal stories about people's suffering. The questions raised are not new but I guess it's good if it brings wider knowledge and more understanding to the dilemmas we all face as we age. ( )
  ellink | Jan 22, 2024 |
I give it five stars despite the book having some shortcomings. For example:

1) The author makes it sound far too likely that people know what makes them happy. (If I had a year/month/week/day to live, I have no idea what I'd want to do. Am I unusual?)

2) Not sure how to put this into practice given that:

- everyone's case is so different,
- you don't have a lot of opportunities to try these ideas out,
- and our knowledge is so incomplete.

3) As the author explains, despite all his knowledge of this material and that both he and father were medical doctors, he still made mistakes when it came to his father.

4) Lastly, I'd have liked the author to talk more about doctor-assisted suicide options. The little he did cover was incomplete and arguable. Consider this passage (hardcopy, p245)

"...by 2012, one in 35 Dutch people sought [legal] assisted suicide at their death is not a measure of success. It is a measure of failure."

The author doesn't explain why it's a measure of failure. Later, he seems to imply the # is too high. But his rhetoric is just too vague and I'm left thinking the # is much too low. In any case, a raw number like that is useless. What we really need to know is the ratio of people who had *the opportunity* for assisted suicide. So the ratio shouldn't take into account, for example, people who were hit by a truck and died instantly.

Still, it's a great read. ( )
  donwon | Jan 22, 2024 |
Mostrando 1-5 de 287 (seguinte | mostrar todos)
His new book, “Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death.

It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.”
adicionada por melmore | editarNew York Times, Sheri Fink (Nov 6, 2014)
 

» Adicionar outros autores (8 possíveis)

Nome do autorPapelTipo de autorObra?Estado
Gawande, Atulautor principaltodas as ediçõesconfirmado
Petkoff, RobertNarradorautor secundárioalgumas ediçõesconfirmado
Pradera, AlejandroTradutorautor secundárioalgumas ediçõesconfirmado
Röckel, SusanneÜbersetzerautor secundárioalgumas ediçõesconfirmado
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I see it now—this world is swiftly passing.
—the warrior Karna, in the Mahabharata

They come to rest at any kerb:
All streets in time are visited.
—Philip Larkin, "Ambulances"
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I learned about a lot of things in medical school, but mortality wasn't one of them.
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Modern scientific capability has profoundly altered the course of human life. People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical profession have proved alarmingly unprepared for it.
In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussions were an experimental drug, the FDA would approve it.
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don't want a general who fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can't, someone who understands that the damage is greatest if all you do is battle to the bitter end.
… our driving motivations in life, instead of remaining constant, change hugely over time and in ways that don’t quite fit Maslow’s classic hierarchy. In young adulthood, people seek a life of growth and self-fulfillment, just as Maslow suggested. Growing up involves opening outward. We search out new experiences, wider social connections, and ways of putting our stamp on the world. When people reach the latter part of adulthood, however, their priorities change markedly. Most reduce the amount of time they spend pursuing achievement and social networks. They narrow in. Given the choice, young people prefer meeting new people to spending time with, say, a sibling; old people prefer the opposite. Studies find that as people grow older they interact with fewer people and concentrate more on spending time with family and established friends. They focus on being rather than doing and on the present more than the future.
Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.
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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.

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