My Thoughts On Being Mortal
Being Mortal by Atul Gawande is a confronting yet fantastic book. As the books subtitle states, Gawande discusses illness, medicine, and what matters in the end. The overall theme of Being Mortal is that instead of focusing on patient longevity with treatment, we should allow for patients to live fulfilling lives.
Gawande delves into how with the huge arsenal of medicine we have in modern healthcare, we still choose solutions which don’t match what patients want. Particularly when it comes to aging patients who will continue to decline despite the wonders of medicine. One of the examples Gawande used is an aged man who had to have some of his ribs broken in order for a tumor to be removed. The patient already had a litany of health issues and despite the surgery going perfectly well the patient would live out his remaining days suffering in hospital and eventually succumbing to an infection. The patient made the decision to operate because he was misguided in thinking that he would be able to regain his strength eventually with surgery. If the patient had understood that with the surgery he couldn’t return to normal he likely would have made different decisions. That part comes down to doctors clearly articulating the options and giving the patient realistic expectations, which is nonetheless incredibly uncomfortable when the patient’s situation is grim.
Another interesting focus of this book is on aged care. Gawande illustrates how nursing homes were born out of a necessity to free up hospital beds. This means that the residents of these homes will simply be treating them as if they were in a hospital rather than attempting to maximize their life experiences now. While there is more care available for patients who require it at these homes they are required to give up privacy and any autonomy they once had. These patients have gone from being respected, valued members of society to being treated like children. This results in the patients feeling depressed and a burden on others, their lives feel meaningless. They are also often lonely as in western society there is an expectation that children move away at some point, and it’s the children who usually end up deciding to put their parents in a nursing home.
In an experiment a nursing home tried bringing animals into the home. While normally there would be 1 or 2 dogs or a cat, this home brought in 4 or more cats and dogs of different sizes as well as 100 parakeets. The home was basically a zoo and what the staff found was fascinating. Patients who had been completely despondent for a long time were all of a sudden chatty with the animals and found purpose in aiding the staff with caring for them. It made the days lively and broke the monotony that had been standard for so long. The staff found that healthcare metrics improved for the patients and that they were even living for longer. Another option Gawande discussed was assisted living, which is similar to independent living but provides extra care for people who need it. Residents at assisted living facilities can choose to not take their pills, eat ill recommended foods, lock their door, and so on. They aren’t forced to give up their privacy and autonomy to receive care. Instead of patients rebelling, the healthcare metrics at assisted living also outperform nursing homes. So much so that some nursing homes now brand themselves as assisted living to appeal to consumers.
My biggest take away from Being Mortal is the importance of having difficult conversations about what we’re prepared to live with. The default solution for most people is to fight illness aggressively right until the very end, but that process takes a huge toll on patients and results in an incredibly poor quality of life that can be dragged on throughout treatment. Instead it is far more useful to discuss with the patient what risks they’re willing to take and tailor their treatment appropriately instead of blindly fighting illness. With this strategy you can make far better decisions as well as opening the door for discussing the merits of hospice care. Hospice care focuses on relieving pain and making the remaining time more bearable, as well as allowing for some good days where the patient can spend a normal day with family. This is a far more humane model of care than dying in an ICU fighting until the end.
Language is crucial when discussing a patients health. Doctors can switch into a mode of presenting the options of treatment to a patient, a menu full of drugs all with complicated names that have different interactions with other drugs, this is dizzying for patients to comprehend. Instead an interpretive approach is preferred where doctors are able to have hard conversations with patients and understand their needs so their treatment will still allow them to live a meaningful life. For patients nearing death, the most aggressive option will often not be the one that allows them to make the most of their remaining time.
In conclusion I relished this book. While mortality is a confronting issue, the finitude of our lives gives us the urgency to do achieve things with the time we have and ultimately live meaningful lives. I hope that when the time eventually comes to have a hard conversation about what we want in life that I’ll be able to, and if I can it will be because of this book. I’d especially recommend Being Mortal to health care professionals and students as well as anyone else who is interested.
