Atul Gawande's "Being Mortal" explores how modern medicine often fails to address the inevitable realities of aging and mortality. Medical training primarily focuses on saving lives, neglecting the processes of aging, frailty, and dying. The book highlights that what the very old fear is not death itself, but the loss of independence, memory, and their way of life.
Gawande presents poignant stories, such as that of Mr. Lazaroff, who opts for a risky surgery with little chance of improving his quality of life, illustrating the medical profession's tendency to pursue interventions even when they may prolong suffering. He contrasts this with the traditional Indian approach to aging, where elders are revered and supported by family.
The book argues that our technological medical system often prioritizes extending life at all costs, even at the expense of patients' well-being and their desires to avoid suffering, maintain mental awareness, and not be a burden. Gawande examines the benefits of hospice care, which shifts the focus from mere survival to providing the fullest possible life in the present, emphasizing pain management, comfort, and maintaining mental awareness. The case of Lee Cox demonstrates how hospice can improve quality of life and even extend it beyond initial prognoses.
"Being Mortal" stresses the critical need for "hard conversations" between doctors and patients about their goals, fears, and trade-offs as they face serious illness. Gawande discusses different models of the doctor-patient relationship, advocating for an "interpretive" approach where doctors help patients understand what they truly want in the context of their medical condition. The story of Susan Block and her father illustrates the importance of these conversations in making informed end-of-life decisions.
The book also explores alternative models of care, such as Bill Thomas's Eden Alternative in nursing homes, which introduces plants and animals to combat boredom, loneliness, and helplessness, and the Peter Sanborn Place, an assisted living facility that prioritizes residents' autonomy and choices. These examples highlight the possibility of creating environments that focus on making life worth living for the frail and elderly.
Gawande emphasizes that individuals want to remain the authors of their own stories until the end. The tragedy of Sara Monopoli's battle with cancer illustrates the default of "doing something" in modern medicine, often leading to aggressive treatments that may worsen the final months of life. The success of Aetna's concurrent care program and the La Crosse initiative demonstrate that early discussions about end-of-life wishes can lead to better outcomes, reduced costs, and greater peace for patients and their families.
Ultimately, "Being Mortal" calls for a shift in perspective, urging medical professionals and society to recognize that the goal of medicine should not simply be to prolong life, but to enable well-being, which includes understanding and honoring individuals' priorities and values, especially as they approach the end of life. The author's personal experience with his father's final days underscores the difficulties even medical professionals face in navigating these challenging decisions and the importance of aligning medical care with personal wishes.