I am not sure what lead me to reading this book. It was certainly a recommendation that resulted from the use of some algorithm, probably Amazon or Overdrive, based on books I have read in the past. But I have no idea which book or books that I have read provoked this recommendation. Many times throughout I found myself wondering how this was related to other books I have enjoyed. Nonetheless, it was an excellent recommendation and I could not put it down.

Being Mortal by Atul Gawande is a book about how our culture handles aging and dying. Gawande is a surgeon who has seen far too much end of life suffering in the well intentioned attempt to fix or give hope in the face of a hard fact of life: that it must eventually come to an end.

Gawande investigates how the elderly have been treated traditionally in a time before our world of fast paced and over committed lives when instead of having strangers care for people at their final days, it was more commonly the role of their descendants. It was a time when multiple generations often shared a dwelling and folks were free to continue writing the story of their lives with a lot more autonomy and meaning than they are afforded by many of today's arrangements.

The focus today, Gawande points out, is instead on safety and health restoration. Safety is often a concern that counters the autonomy that gives life meaning. It is also most often a priority of the family, friends, and doctors rather than the ill-fallen person themselves. The traditional setup of nursing homes is for the peace of mind of the brood of the elderly who are often making the decisions as well as the efficiency of the institution rather than focusing on what the needs of the residents are.

Often times when patients find themselves in a condition that is unlikely to be repaired they hold out hope that they can go back to the way things were prior to the ailment. It is not just the patient and their family that hold on to these hopes, but the doctor as well. Gawande points out that, statistically, doctors predictions for how long someone with a life threatening disease will live are on average longer than what really ends up being the case.

Doctors also often see their role as one to fix the problem and are dumbfounded as to how help them realize which choice is best for the patient on an individual level, especially when that best choice is less aggressive. Gawande describes two typical types of doctors. Those who are authoritarian, or as he puts it, paternal. These are the doctor knows best types. Then there are doctors who simply lay out all the options in a very informative manner. A sort of, “here are your options, pick one” scenario.

A third option proposed by Gawande is a what he calls shared decision making. There are a few questions, albeit difficult ones, that can help get down to what the ill really wants to do. What are your biggest fears and concerns? What goals are most important to you? What sacrifices are you willing to make and unwilling to make? Having these hard discussions can tremendously help everyone involved help find the decision that is best for the individual.

Unfortunately, this kind of care is not common. It is just not how a lot of doctors see their role. There is hope though. Gawande writes of assisted living centers that have started to focus more around the needs of the residents. The advanced directive is a step in the right direction and palliative care is becoming a wider spread specialty. However simply being a specialty is not enough. Doctors in general as well as families and loved ones need to start addressing these questions before we can be truly sensitive to providing the absolute best quality of life possible in the end. 

I highly recommend giving this book a read.

Kirk Aug

Kirk is SeedSing's writer on society, science, and whatever else his brain may fancy. He received the good reading certificate in elementary school 5 out of six years. Follow him on twitter @kirkaug.