Being Mortal
By Atul Gawande
š The Book in 3 Sentences
- This book gives many vivid examples of the struggles and choices of terminally ill people and aging people.
- This book introduces different hospice services currently offered in developed countries and their pros and cons.
- This book asks profound questions that lead the readers to think what one wants to prioritise when it comes to the time of choosing between different caring and medical options.
š Actionable Takeways
- Assess every a couple of years about what trade-offs I am willing to make and not willing to make when it comes to a difficult medical choice.
- Discuss this question with my mother and with my partner.
- Eat well, sleep well, exercise, manage stress. Prolong my healthy and able quality life as much as I can.
āļø How the Book Changed Me
- Health comes before work and money. Thinking through the difficult choices one will have to make when facing critical illness and debility, it suddenly becomes very clear that I do not want to achieve work objectives or make more money at the cost of my health.
- Medical interventions and the risks and complications associated are only worth it when the aftermaths still give me moments worth living for each day.
- Assisted living is more important than assisted death. We as a society needs to have consensus on it and allocate resources to advance the field and make it more accessible to everyone.
š Summary + Notes
Summary
Being mortal is about the struggle to cope with the constraints of your biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, but failing to acknowledge that such power is finite and always will be can do damage.
Medicine should be more than to ensure health and survival. It should enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?
If to be human is to be limited, then the role of caring professions and institutionsāfrom surgeons to nursing homesāought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a personās life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.
Notes
The single most serious threat for elderly people is falling.
Geriatrics: what they do is to simplify medications.
A good example of managing oneās aging life: save; not retire early; keep social contacts and avoid isolation; monitor oneās bones and teeth and weight.
What makes life worth living when we are old and frail and unable to care for ourselves?
People with serious illness have priorities besides simply prolonging their lives, of which the top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete.
In ordinary medicine, the goal is to extend life. Weāll sacrifice the quality of your existence nowāby performing surgery, providing chemotherapy, putting you in intensive careāfor the chance of gaining time later. Hospice deploys nurses, doctors, chaplains, and social workers to help people with a fatal illness have the fullest possible lives right now. In terminal illness that means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as feasible, or getting out with family once in a whileānot on whether oneās life would be longer or shorter.
If end-of-life discussions were an experimental drug, the FDA would approve it.
The lesson (of end-of-life discussions and hospice) seems almost Zen: you live longer only when you stop trying to live longer (via medical interventions).
4 crucial questions:
- Do you want to be resuscitated if your heart stops?
- Do you want aggressive treatments such as intubation and mechanical ventilation?
- Do you want antibiotics?
- Do you want tube or intravenous feeding if you canāt eat on your own?
The primary purpose of a discussion about terminal illness is helping people negotiate the overwhelming anxietyāanxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances. According to palliative specialists, you shouldnāt say, āIām sorry things turned out this way,ā for example. It can sound like youāre distancing yourself. You should say, āI wish things were different.ā You donāt ask, āWhat do you want when you are dying?ā You ask, āIf time becomes short, what is most important to you?ā
Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength. At least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortalityāthe courage to seek out the truth of what is to be feared and what is to be hoped. The second is the courage to act on the truth we find. The problem is that the wise course is so frequently unclear. The challenge is one has to decide whether oneās fears or oneās hopes are what should matter most.
The system of assisted death may have reinforced beliefs that reducing suffering and improving lives through other means (such as palliative care programs) is not feasible when one becomes debilitated or seriously ill. We damage entire societies if we let providing assisted death divert us from improving the lives of the ill. Assisted living is far harder than assisted death, but its possibilities are far greater, as well.