- Paperback: 296 pages
- Publisher: Penguin Books India; Latest Edition edition (16 December 2015)
- Language: English
- ISBN-10: 0143425579
- ISBN-13: 978-0143425571
- Package Dimensions: 19.6 x 12.8 x 2.8 cm
- Average Customer Review: 203 customer reviews
- Amazon Bestsellers Rank: #936 in Books (See Top 100 in Books)
Being Mortal: Medicine and What Matters in the End Paperback – 16 Dec 2015
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About the Author
Atul Gawande, MD, MPH, is a surgeon, writer, and public health researcher. He has written four New York Times bestsellers: Complications, Better, The Checklist Manifesto, and most recently, Being Mortal: Medicine and What Matters in the End. He is the winner of two National Magazine Awards, AcademyHealth’s Impact Award for highest research impact on healthcare, a MacArthur Fellowship, and the Lewis Thomas Award for writing about science.
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As the author so succinctly puts it, specialist doctors now-a-days are trained to 'fix' a particular problem. Elderly patients suffering from multiple ailments are brought to a hospital by their anxious relatives. Once inside the hospital complex, the patient is taken over by a regimented system. He loses his autonomy. Human warmth is in short supply and there is a certain chill in the atmosphere. Doctors do not have the time or inclination to have detailed discussion with the patient or his relatives. The system is heavily weighed in favour of the service provider, i.e., the hospital administration, doctors, pharmaceutical companies, insurance companies etc. The service seeker is left at the mercy of the heartless system.
The title of the book reminds us that man is after all mortal. In many cases, hospitals prolong life unnecessarily, painfully and at an exorbitant cost. An old and infirm person prefers to spend his last days at a place that provides homely comfort and medical care at an affordable price. The author cites several innovative models being tried by people dedicated to the cause of alleviating human suffering.
'Being Mortal' had a profound impact on me partly because I happened to read it when I had not yet recovered from the shock of my eighty five old mother's painful death. She was quite healthy in body and spirit until she was eighty. Then she had a sudden fall and broke her hip bone. An operation was done on her and a metal plate was implanted. A walking stick enabled her to walk on the level ground with difficulty. Her confidence was shaken as she lost her mobility. She considered herself a burden on the family. She became morose. Members of the family had little time to waste on her. She spent the day sitting alone on a chair in a dimly lit room and looking vacantly at a T.V. set. She had become incontinent. She was afraid she might wet the bed. Having lost her autonomy, she slowly sank into an abyss of dreadful agony which was reflected in her melancholy eyes. She often asked me piteously, " How long have I to live like this?" I had no answer. One day she stopped talking and eating altogether. She was admitted to a hospital. Doctors diagnosed it was a case of aspiration pneumonia. The pneumonia was controlled. But she never regained her ability to talk, drink or eat. She was brought back home. She spent her last days confined to her bed with all sorts of tubes sticking out of her frail body. Early one morning death came as a relief to her pain and shame.
A year has passed since my mother's death. Meanwhile I read 'Being Mortal'. The book's message rattled me. Nothing is more precious to a dying person than a smiling face or a loving gesture. Did my mother receive it in ample measure during the last phase of her life? Doubts linger.
In the book Atul introduces us to a variety of patients, each having a different personality, handling their terminal illness differently. First is Joseph Lazaroff, in his sixties, suffering from incurable cancer who says, “Don’t you give up on me, you give me every chance I’ve got”. Next was Atul’s grandfather (110) who lived tending to his farm in India until one-day he fell down and developed a subdural hematoma, the same condition my dad suffered after his fall. Alice Hobson, at 82 was in pink of health was living independently herself in an own house, things started to change when she started falling down often and eventually had to move to a community that offered a continuum of care. Atul even follows a geriatrics by name Felix Silverstone, who had handled aged patients for five decades, on how he handles his own old age & associated illness.
This wide set of case studies benefits us, the readers, to understand the subject broadly. In each of the cases, we see the dilemma faced by all stakeholders on when to call off active treatment. The patients, their caretakers and doctors are faced with the question of deciding on when interventions become pointless – when do you allow the patient to live a painless life or put them through more suffering just for the sake of prolonging their life.
Atul looks into where the old with illness should be treated, how can the loved ones take care of them? Should it be in their home risking not having continuous medical care, or at a Geriatrics Clinic (Center for Adult Health), or in a retired community, or in a Nursing home. The author goes through each of them in detail by giving examples, interviewing people and sharing their experiences. In some horrible places he says, the battle for control between the patient and the staff escalates until they lock them in a Geri-Chair or they chemically subdue with psychotropic medications.
Taking care of elderly is not for the faint-hearted. Having experienced myself, during the instances when I had to dress my father for bed-sore due to his limited mobility in his last month’s I can relate to an experience told to Atul by a caretaker of an assisted living facility – “Dressing somebody is easier than letting them dress themselves. It takes less time. It’s less aggravation”. Very true. Similarly, when I remodelled my parents’ room a few years back, I focused on it being safe and not on their personal preference, an experience captured by the following quote in the book – “We want autonomy for ourselves and safety for those we love”.
Atul sees a society that handles the final phase of the human life cycle by trying not to think about it, by handling any number of society goals – but never the goal that matters to concerned people: how to make life worth living when they’re weak and frail and can’t fend for themselves anymore.
In his experience, the writer has seen people with serious illness have priorities besides simply prolonging their lives, their top concerns include avoiding suffering & strengthening relationships with family and friends. He writes of a campaign followed from 1991 in the community of La Crosse, Wisconsin where medical people and patients discussed end-of-life wishes: Do you want to be resuscitated if your heart stops? Do you want aggressive treatments such as mechanical ventilation? and so on…
The author writes that the incentives, not only financial, are put in place to encourage Doctors to do more intervention than less. Modern medicine has failed to acknowledge the power of medical science to push against the limits of our biology, and it is time medicine accepts its role is about a larger well-being of people.
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The problem is that I received a damaged product. The spine of the book was torn. Not happy about that.Read more
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