Being Mortal

Tina Vajpeyi reviews the book Being Mortal by Dr Atul Gawande


The world over, medical professionals
are taught how to cure people and how to keep them alive. No course provides
in-depth or extensive training on how to handle those who are dying and in
particular, elderly patients who are nearing the end of their lives. Anywhere
in the world, the percentage of doctors specialising in geriatric care is
minuscule.

The ‘do no harm’ principle that is a cornerstone of the medical profession
means that doctors are not supposed to determine how and often when, a life
ends. Unfortunately, most relatives and friends are not prepared to have those
conversations with doctors, or even amongst themselves. Nor do any courses
teach doctors how to talk about such issues with patients, their families,
friends and care-givers.

Written in fluid prose, best-selling
author Dr Atul Gawande’s book, Being
Mortal includes research and analysis into elder care and discusses what
matters most to people as they age and become physically dependent,
and encompasses various thought-provoking perspectives on the subject.

Drawing from his decades of
experience as a surgeon and writer-researcher in the West, and the experiences
of his family in India, Gawande compares and discusses the two varying
scenarios. In India, until recently, it has mainly been the extended family
that cares for the elderly, whereas in the United States, elderly people are
mostly being cared for in privately-run, assisted-living facilities or living
independently, for longer periods of their lives.

The book provides interesting
statistics to explain the changing dynamics of family as technology and
healthcare improve. In the US, for example, only 17% of the elderly now die in
their own homes; whereas it was once the norm to pass away peacefully at home,
death now often occurs whilst a patient is connected to machines in an ICU, in
a hospital bed or while living in a nursing home.

The book also dwells on how medical insurance, advances in medical technology
and treatments, and improved healthcare are changing attitudes about, and the
dynamics of, mortality. More and more people are now trying to live longer,
irrespective of the quality of their lives. The author highlights the dilemmas
that people grapple with when confronted with aging, illness and imminent
death, and provides examples of how both families and patients themselves have
made difficult decisions.

While the west has been addressing
the subject of home care and retirement living for some time now, more
traditional societies like India are less prone to do so because of ingrained
family mindsets regarding caring for the elderly and also, a generalised
avoidance of open and informed discussions about what matters most towards the
end of our lives.

While all doctors and those involved
in caring for the elderly – family or organizations will find this book
immensely useful as they confront the subjects covered by it daily, Being Mortal really is a book for
everyone, since it deals with ageing and mortality, a fate none of us can escape.
And its language and treatment of its subject is such. Accessibly written,
analytical and provocative, it will make the reader think about healthcare,
treatment and end-of-life issues that they ought to consider as they age. 

Dr Atul Gawande is the author of four books, all of them New York Times best-sellers, including
his latest, Being Mortal. He is a winner of
the Lewis Thomas Prize, awarded for
science writing, and two National Magazine Awards. Complications, Better and
A Checklist Manifesto are his other works. A surgeon by profession, he practices at Brigham and
Women’s Hospital, Boston and is a
professor at Harvard Medical school and Harvard School of Public Health, and a public
health researcher. He is also Chairman of Lifebox, a non-profit organization
making surgery safer globally. 

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