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Being Mortal: Medicine and What Matters in the End Hardcover – Deckle Edge, 7 Oct 2014
|Hardcover, Deckle Edge, 7 Oct 2014||
Special deckle edge formatThis book has a deckle edge format with distinctive, feathery edge papers. The deckle edge adds a decorative, textured edging to the book.
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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
About the Author
Atul Gawande is author of four bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon as one of the ten best books of 2007; The Checklist Manifesto; and his most recent, Being Mortal. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Executive Director of Ariadne Labs, a joint center for health systems innovation, and chairman of Lifebox, a nonprofit organization making surgery safer globally. He and his wife have three children and live in Newton, Massachusetts.
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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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