Being Mortal: Medicine and What Matters in the End

I think anyone who who might have to help loved ones deal with their deaths in the future, or who may one day be faced with their own mortality, will find this book enormously interesting and helpful. You know who you are. ( )

Everyone needs to read this book. ( )

This is the ideal book for considering the details of aging, death and dealing with the medical system today. He began first by exploring different models of senior living - looking closely at nursing homes, assisted living facilities, other creative ways to grow old, and the histories behind them. Often the mandate of safety at these places undermines autonomy and even quality of life.

Gawande also writes to critique the way medicine is performed today - rather than a no-holds-bars fight for survival, the goal ought to "enable well-being." Life, it turns out, is often prolonged beyond what the elderly actually desire. He writes, "The debate is about what mistakes we fear most — the mistake of prolonging suffering or the mistake of shortening valued life.” Often having those hard conversations with your parents (or anyone who is actively dying) can be a blessing to know how to proceed, because when doctors are told to "do everything you can" in keeping someone alive, there's almost always something else they can try.

Toward the end, he highly praises hospice care work and the ways it makes the end of your life more tolerable and reduces unhelpful medical costs. I should note, Gawande is a wonderful story-teller and interweaves stories throughout to exemplify his points.

A closing favorite quote: “Arriving at an acceptance of one’s mortality and a clear understanding of the limits and the possibilities of medicine is a process, not an epiphany.” This was for me the reason to read it. ( )

It took me 2-3 hours to really get into the book, but in the end I enjoyed it primarily because it made me think about issues I never before examined. What I took away from Gawande's discussion of the last months/weeks of our lives is that communication is key. The common thread that ran through all of the poor outcomes for people near death had to do with a failure by someone to have a difficult discussion -- that could be the aged individual themselves, their relatives and loved ones, or perhaps the doctors/nurses in charge of care. Usually it was a combination. But when people were willing to confront reality and examine what future they desired when life neared the end, the outcomes were far better.

I am grateful that I stumbled upon this before I was thrust into a situation where I would need the information. As Gawande writes, if you don't plan for eventualities at least a little in advance, your outcomes are likely to be much worse than if you had put even minimal effort in up front. This book is something I hope I will remember to come back to and re-read when I feel the information might be needed soon.

Below, I reproduce 5 questions Gawande encourages those with serious illness answer for themselves. Ideally, you will share this with those providing care as well as those that may be making life/death decisions for you if you become unable to do so yourself.

1. What is your understanding of where you are and of your illness?
2. What are your fears or worries for the future?
3. What are your goals and priorities?
4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?
5. (later) What would a good day look like? ( )

I learned a lot from this book about things we don’t like to discuss. you can read more about my lessons learned from this book here: https://captivatedbycuriosity.com/2019/01/14/mortality-and-how-to-live-a-better-...

What is really best for your aging parent? How did dying in a nursing home come to be the norm? What key questions should you ask when looking death in the eye?

While answering these hard questions, he intertwines compelling and endearing stories of real people that show how things often end up and what happens when you don’t allow the medical system make decisions for you.

It’s a great read. Not an easy book to read in terms of facing the content and contemplating your and your loved ones future, but definitely helpful and calming with the only certainty we have in life. ( )