Being Mortal

August 1, 2014
A prominent surgeon and journalist takes a cleareyed look at aging and death in 21st-century America. Modern medicine can perform miracles, but it is also only concerned with preserving life rather than dealing with end-of-life issues. Drawing on his experiences observing and helping terminally ill patients, Gawande (The Checklist Manifesto: How to Get Things Right, 2009, etc.) offers a timely account of how modern Americans cope with decline and mortality. He points out that dying in America is a lonely, complex business. Before 1945, people could count on spending their last days at home. Now, most die in institutional settings, usually after trying every medical procedure possible to head off the inevitable. Quality of life is often sacrificed, in part because doctors lack the ability to help patients negotiate a bewildering array of medical and nonmedical options. Many, like Gawande's mother-in-law, Alice, find that they must take residence in senior housing or assisted care facilities due to the fact that no other reasonable options exist. But even the most well-run of these "homes" are problematic because they can only offer sterile institutional settings that restrict independence and can cause psychological distress. Moving in with adult children is also difficult due to the tensions and conflicts that inevitably arise. Yet the current system shows signs of reform. Rather than simply inform patients about their options or tell them what to do, some doctors, including the author, are choosing to offer the guidance that helps patients make their own decisions regarding treatment options and outcomes. By confronting the reality rather than pretending it can be beaten and understanding that "there are times where the cost of pushing exceeds its value," the medical establishment can offer the kind of compassion that allows for more humane ways to die. As Gawande reminds readers, "endings matter." A sensitive, intelligent and heartfelt examination of the processes of aging and dying.

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Starred review from October 1, 2014
Distressed by how the waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver's chance of benefit, surgeon Gawande (The Checklist Manifesto, 2010) confronts the contemporary experience of aging and dying. Culture and modern medicine encourage an end-of-life approach that focuses on safety and protection but is sadly shallow. He frets that residents of nursing homes are often lonely and bored. Physicians are keen on intervening whenever a body is diseased or broken. Yet this medical imperative applied to terminally ill individuals can be frustrating, expensive, and even disastrous. Gawande suggests that what most of us really want when we are elderly and incapable of taking care of ourselves are simple pleasures and the autonomy to script the final chapter of life. Making his case with stories about people who are extremely frail, very old, or dying, he explores some options available when decrepitude sets in or death approaches: palliative care, an assisted living facility, hospice, an elderly housing community, and family caregivers. One of these stories is the impassioned account of his father's deterioration and death from a tumor of the spinal cord. As a writer and a doctor, Gawande appreciates the value of a good ending.(Reprinted with permission of Booklist, copyright 2014, American Library Association.)

May 15, 2014

Leading surgeon, Harvard medical professor, and best-selling author, Gawande is also a staff writer at The New Yorker, which published the National Magazine Award-winning article that serves as the basis for this study of how contemporary medicine can do a better, more humane job of managing death and dying.

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