- Hardcover: 304 pages
- Publisher: Metropolitan Books; 1 edition (7 October 2014)
- Language: English
- ISBN-10: 9780805095159
- ISBN-13: 978-0805095159
- ASIN: 0805095152
- Product Dimensions: 14.4 x 2.7 x 21.4 cm
- Customer Reviews: 8,863 customer ratings
- Amazon Bestsellers Rank: #97,701 in Books (See Top 100 in Books)
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Being Mortal: Medicine and What Matters in the End Hardcover – Deckle Edge, 7 October 2014
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“Being Mortal, Atul Gawande's masterful exploration of aging, death, and the medical profession's mishandling of both, is his best and most personal book yet.” ―Boston Globe
“American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande's most powerful--and moving--book.” ―Malcolm Gladwell
“Beautifully crafted . . . Being Mortal is a clear-eyed, informative exploration of what growing old means in the 21st century . . . a book I cannot recommend highly enough. This should be mandatory reading for every American. . . . it provides a useful roadmap of what we can and should be doing to make the last years of life meaningful.” ―Time.com
“Masterful . . . Essential . . . For more than a decade, Atul Gawande has explored the fault lines of medicine . . . combining his years of experience as a surgeon with his gift for fluid, seemingly effortless storytelling . . . In Being Mortal, he turns his attention to his most important subject yet.” ―Chicago Tribune
“Beautifully written . . . In his newest and best book, Gawande . . . has provided us with a moving and clear-eyed look at aging and death in our society, and at the harms we do in turning it into a medical problem, rather than a human one.” ―The New York Review of Books
“Powerful.” ―New York Magazine
“Atul Gawande's wise and courageous book raises the questions that none of us wants to think about . . . Remarkable.” ―John Carey, The Sunday Times (UK)
“A deeply affecting, urgently important book--one not just about dying and the limits of medicine but about living to the last with autonomy, dignity, and joy.” ―Katherine Boo
“Dr. Gawande's book is not of the kind that some doctors write, reminding us how grim the fact of death can be. Rather, he shows how patients in the terminal phase of their illness can maintain important qualities of life.” ―Wall Street Journal (Best Books of 2014)
“Being Mortal left me tearful, angry, and unable to stop talking about it for a week. . . . A surgeon himself, Gawande is eloquent about the inadequacy of medical school in preparing doctors to confront the subject of death with their patients. . . . it is rare to read a book that sparks with so much hard thinking.” ―Nature
“We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. However it is not only medicine that is needed in one's declining years but life--a life with meaning, a life as rich and full as possible under the circumstances. Being Mortal is not only wise and deeply moving, it is an essential and insightful book for our times, as one would expect from Atul Gawande, one of our finest physician writers.” ―Oliver Sacks
“Gawande's book is so impressive that one can believe that it may well [change the medical profession] . . . May it be widely read and inwardly digested.” ―Diana Athill, Financial Times (UK)
“Eloquent, moving.” ―The Economist (Best Books of 2014)
“A great read that leaves you better equipped to face the future, and without making you feel like you just took your medicine.” ―Mother Jones (Best Books of 2014)
“Beautiful.” ―New Republic
“Gawande displays the precision of his surgical craft and the compassion of a humanist . . . in a narrative that often attains the force and beauty of a novel . . . Only a precious few books have the power to open our eyes while they move us to tears. Atul Gawande has produced such a work. One hopes it is the spark that ignites some revolutionary changes in a field of medicine that ultimately touches each of us.” ―Shelf Awareness (Best Books of 2014)
“A needed call to action, a cautionary tale of what can go wrong, and often does, when a society fails to engage in a sustained discussion about aging and dying.” ―San Francisco Chronicle
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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.
The topic by itself is not new, having drawn numerous thinkers, philosophers and the likes into its folds. It is a tricky topic to deal with and this book gives us a fresh perspective as the author is a surgeon and has done significant work in the field of public health.
The book is divided into 8 chapters and the introduction tells us about Atul’s encounter with a gentleman suffering from metastatic prostate cancer and who lost his wife to lung cancer. He depicts the struggles of the treatment choices and the patient’s choices who refused to give up when presented with the odds.
Through extensive research and interviews, Atul takes us on a journey to understand our mortality. The inevitable decline of our bodies, the origins of assisted living, hospices and the like are all discussed in an easy to understand fashion. He also deals with the most grey and difficult area of medicine – decision making. How does one deal with bad news? How does one convey it effectively to the patient? How does one present difficult choices to a patient? Is modern-day medicine providing useful life to end-stage patients or only prolonging their suffering? Atul tries to answer these and many other questions with real-life examples. The story of his own father’s struggle with a spinal cord tumour is very moving and beautifully written.
He talks about the importance of the ‘dying role’ and how it’s been forgotten in this technological world. If we deny this role to our patients then are we really doing it right, he wonders.
A must read book for every doctor, paramedic and anyone who wonders about mortality and the choices at life’s very end...
Top international reviews
The book is just over 280 pages, split into eight chapters by subject.
I was slightly scared to read this book as I expected it to force me to confront emotions that I usually bury. And it's true that there were some very familiar issues dealt with regarding the quality of life and the moralities of the healthcare system forcing people to live longer than they actually should be able to.
The narrative is very easy to read . It is direct, not avoiding difficult subjects and discussing decline/death in the way that you would hope of a physician.
It should be noted that this is a US author so the statistics and examples are all from the US. The easiest way to approach this from the UK is assume that everything is the same here but, of course, that isn't necessarily true.
Many problems are raised with the system but, unsurprisingly, not too many solutions are discussed. It is never going to solve problems but will provoke thought which I think is its main purpose. The ideas that are raised are very plausible though and worthy of trying out.
There are many points in the book where the author theorises and I thought that it was much more effective when he used real examples to illustrate what he is trying to say.
He tackles geriatric care very openly but when he moves on to the mortality of terminally ill younger people the book becomes more controversial - money is always a limiting factor and we are asked to think about whether extending a life temporarily (and miserably) is sensible - he actually refers to this option being the "default choice" of many people in the medical world.
Being Mortal's main focus is on how medicine and medical care has maybe skewed our perception on what it means to live. Does the quality of the life we have at the end often get overshadowed by a focus of extending our life -- even if this extension comes at the cost of stripping our final days of everything that gives meaning to a definition of "Life".
The book begins by investigating the kind of care that is offered to our culture's elderly; a care that can, more often than not, remove as much of their autonomy and dignity as possible in favour of safety. The latter half of the book then moves into discussing the kind of medical direction that is adopted with/by those who are diagnosed as terminally ill.
In both cases, Dr Gawande, eruditely and with much sensitivity, proposes that a better kind of end-of-life-care would be given, and a better quality/freedom of life would be had, if we moved our focus away from trying to ward off the inevitable and placed it instead on assisting and cultivating what life there is remaining. Gawande's proposition is for a more considered medical approach towards those facing the final chapter of their story; one that would allow people to maintain as much control of their life as possible. In such cases the question is not a matter of "would we like to live or die", but what quality of life would we like to have available to us prior to the end, and what levels of quality are we prepared to "trade" in order to extend what little time we have left? The concern of medicine and care would therefore be more inclined in providing the patient with an attainable desired life and not putting them through unnecessary cycles of treatments which, inevitably, erode what quality of life could be had whilst giving so little time (if any) back in return. In such an application, the "well-being" (physically, mentally and emotionally) of the patient would be more important than treating the incurable.
In short, could our current medical practice (along with our own expectations of what medicine is for/about) be failing those who are facing death by preventing them from experiencing as much life as is possible in their final moments?
Such an approach does require us courageously accepting our own mortality; which is a modern challenge in the technological age we live in, and something our ancestors never really struggled with. But this acceptance would lead us towards embracing a life we can have now instead of forfeiting this for something that, sadly, lies beyond our reach.
At this point, some may be thinking that Being Mortal is about Euthanasia. Although this highly complex ethical issue is briefly discussed within the book's eighth chapter (entitled Courage), the context of the book is not arguing for prematurely bringing someone's life to close ("assisted dying"), but improving the quality of life for those who are terminal, and helping them to best prepare, both emotionally and physically, for this end. In other words, this book is arguing for "assisted living". That said, I'm certain that both sides of the Euthanasia debate would find much food for thought within Dr Gawande's writing, along with examples that could be taken to both strengthen and challenge their held positions. Personally, I'm not sure whether the topic under discussion within this book would fall under the header of Euthanasia; it could be argued that prolonging treatment to fight a terminal illness that has already won, could lead into an earlier death.
I found this book extremely fascinating, poignant and sobering. I'll admit, at the age of thirty-five, the quality of life I would desire at my own end isn't something I've given much thought to. I have now. Reading this book will certainly have that affect on you. But the book has also made me think a lot about others, especially the elderly I know and love.
Death, and preparing for it, is such a difficult topic to discuss. So I admire Dr Gawande's courage and compassion as he navigates this issue; and he navigates it very well. To help him in this task, many personal stories from those who have faced this natural crisis have been used; even Atul's own moving description of his father's last years. At first, I found some of the core issues raised by these stories repetitive; wondering whether they could have been condensed together. However, with the hindsight that birthed when I was about three quarters of the way through this book, I became very grateful for every syllable. These personal words help to enlarge our perception of what it means to live; they enable us to grasp how universal our hopes and fears are when it comes to preparing for the end of our own tale.
It is -- though it may seem a very awkward thing to read in public -- an excellent book. One that maybe we all should read.
-- Tristan Sherwin, author of *Love: Expressed*
He continues his research into the treatment of the older generation in the medical arena. Why he wonders, do so many octogenarians have to suffer painful operations which not only don’t improve their life quality but often downgrade it by causing daily ongoing pain. He looks at the percentage of elderly who die in hospital surrounded by tubes and medics but not by their loved ones and looks at where most of us would prefer our last breath to be drawn- at home with our family in a peaceful and familiar environment or attached to myriad tubes and bed pans with bleeping machines and uniformed medics checking us every hour.
He examines our modern quest for immortality and extending life well beyond our ‘pleasurable’ life span, and again asks how and if this really benefits us? Living for many extra years but immobile, semi parálised and on a Cornacopia of drugs is not really something most thinking adults would wish for themselves or their loved ones. But as he points out, humans have to learn and accept our own mortality, accept being mortal and, eventually dying.
This is a very moving and sensitively written book on a subject that many of us avoid discussing until it’s too late. It puts a very different perspective on the need for Hospices where infirm elderly people can be cared for with compassion and dignity rather than being regimented in a medicalised hospital environment however caring the staff. It ask many deep and searching questions and really challenges the modern perceived view of mortality .
I look forward to reading more of his works.
I would absolutely recommend this book to everyone to read. You never know when this book may be of practical use. I intend to keep it close to me forever.
Experience in the US (and this book is based upon the US environment) suggests that personal choice and freedom to make decisions are a vital part of living. So the regimentation of homes for the elderly can, not surprisingly, have a deleterious effect on the life and well being of the elderly in care homes; examples are cited where the need for medication has dropped when the regimentation has ceased and the people in the care homes get control.
Many of the anecdotes from Mr Gawande, who is a surgeon, are from personal experience. Some are about members of his own family and many of these anecdotes are quite moving.. This is a book which should inform the care of the terminally ill and the elderly.
My one quibble (and the reason why it is four stars rather than five) is that there are areas where scientific evidence rather than anecdote would be useful. Many books from 'snake-oil salesmen', particularly in the US, use the same anecdotal approach to extol the virtues of whatever they are trying to sell. Rigorous trials and peer-reviewed studies are always necessary.
There are a lot of discussions based around real cases and Atul is exceptionally brave as he discusses the issues around his own fathers death. My only criticism of this book is that whilst we think we know how end of life care could / should be delivered there is not a huge amount of how we can provide it and how we as society can fund it. The discussions around patient freedoms and their safety are discussed at length with society being on the side of health and safety rather than promoting the individuality of the patient.
At a personal level this book has changed the way I think about the aging and revered members of the family and I can see small ways that I can support independence as the inevitable starts to be seen on the horizon.
If you enjoy this book have a look at Atul's other work, well worth reading.
The second half, which I found most moving, looked at end-of-life choices, focussing on options for a 'good dying' which seeks to optimise a person's life values and goals in the given situation. Even at 58, and relatively healthy, the issues raised seem worthwhile and something to think and talk about with children.
Old age, sickness and death were what the young Buddha saw all around him when he first ventured into the world. Despite developments in modern medicine these facets of the First Noble Truth remain an unavoidable consequence of life. Gawande's contemporary take on these, along with his reflections on how we might approach them in a more humane way, is a valuable contribution to the debate on how we might improve the way people experience the end of their lives.
'Being Mortal" has blown me away. My mother died in a nursing home about 18 months ago, and I did not have the benefit of the insight and guidance of this book, which I greatly regret. I cannot go back and change her experience, but thanks to you, I can advise on better ways of allowing elderly relatives to live out their numbered days with meaning and peace. I can plan my last days, and those of my spouse, with my family and with meaning and a sense of fulfillment. I intend to read it again soon. Thank you. Christine
An interesting dichotomous view of medicine vs sociology from the very able perspective of the author. By sharing his personal disclosures leads the reader into thought-provoking territory.
Took this on holiday and demolished it in a few hours - I could not put it down.