I don’t even know how to begin talking about this book. Atul Gawande is a surgeon who has written several books before this one. Being Mortal is, essentially, about dying in a time in human history when more can be done to prolong life than ever before. But the question has become: “To what end?” The medical profession has become so focused on preserving life at any cost that when it comes to the inevitable end there is no dignity in it, but there could be. Gawande posits that there is a better way, lots of better ways, actually, to face the end of life.
When my boss read this book she emailed all of the doctors in our practice and said that everyone needs to read it, because she saw that a lot of the ideas could be applied to veterinary medicine, and also because we all have aging parents, and we ourselves are aging. I got to read it first because, well, we share books.
Gawande organized this book really well. He started with general discussion and then talked about a few alternatives to the traditional “nursing home” that he visited while he was working on the book, and tells us about a few people he met at each place. The uniting factor amongst these alternative places is that they have returned choice and free will to the residents of these homes, and what about that word, “home”? The people who run these residences have gone out of their way to make their places feel like home to the residents. It seemed to help a lot.
Gawande then moved into talking about some of his own patients, and cases that went well and badly as far as providing a good death for these people. This section was the one that applied the most to my veterinary life, because Gawande was writing as a physician, and trying to help his patients and their families make the best decisions for them about the last few months/weeks/days of their lives. He also talked about the three different types of physician: the kind who tells the patient what the plan is, the kind who give the patient multiple possible plans and lets him or her decide, and the kind who lays out options and then makes a recommendation on what she thinks is the best plan for that particular patient. Gawande said that he tends to be the second type, but that he’s trying to be more of the third type. I started thinking about the kind of veterinarian I tend to be, and I think I’m generally the third, but when it comes to the more sick patients, the ones I know are at the end of their lives, I definitely tend to be more of a “this is what we are going to do” type, because I don’t want to prolong an illness that I know isn’t going to end well, and I’ll do everything I can to spare that poor cat or dog any additional misery. I do think I prefer to be the options with advice type of veterinarian, but I know that the give options and no advice is the easiest way to practice, because the stress of decision-making is off of our shoulders.
The last section of Being Mortal was about the death of Gawande’s father, and how his family made it a good death for him. I cried, of course. Dr. Gawande, Sr., himself a physician, develops a slow-growing spinal tumor. It starts in typically vague manner, and progresses to extreme weakness and near paralysis at the end. The interesting decision that Dr. Gawande makes when faced with his initial diagnosis is to forego surgery until his symptoms had progressed to the point that his quality of life is diminished, when learning that the surgery itself could leave him even worse off than he was prior. Doing so makes the possibility of a cure much less likely—because the longer the tumor sits there, the more likely it is to become so big that it isn’t resectable, or for it to spread to other tissues. Most people would, I think, go for the chance of cure, but Dr. Gawande chooses to enjoy his life, but possibly shorten it… He and his family make this decision over and over in his last couple of years of life, and it seems to me that they did it the same way I hope I’ll be able to someday.
Emotion definitely builds as the book goes on, and I think that was the right way to go about this topic, from more clinical to more personal. I think that if Gawande had started with the story of the death of his father it would have been much too heavy, and he probably would have lost some readers. Being Mortal is the first book I’ve ever reviewed that I will say, in no uncertain terms, that has something for everyone, and is important for all of us to read. Like, I don’t even care if you enjoy reading it or not (though I think you will), you just need to know what it has to say.