Being Mortal by Atul Gawande

I got sent this book as part of a book exchange and I'm so glad I got it because it was an excellent and thought provoking read.

Being Mortal is a look at aging and death from the perspective of a doctor. Atul Gawande weaves studies and facts in between the stories of his patients and at the end, the story of his father. There are several topics but I think they can be grouped into two categories:

1. How should we, as a society, handle the problem of aging?

Nursing homes tend not to make their residents happy, because of the lack of autonomy and independence. But the people who chose the nursing homes tend to be the kids, who consider the question "do I feel okay leaving my parent here?" more than the question "will my parent feel happy here?"

The book looks at nursing homes today and explores several alternatives, also while talking about the effects of aging.

2. How far should doctors go when trying to save a life?

Medicine tends to focus on the promise of time (even if it's just a little more time), which may come at the expense of quality of life. But how do doctors know what balance to strike?

This requires talking to the patient and understanding their needs and wants. Ask them things like "how much pain/how far will you accept a deteriorating quality of life in order to get some extra time?"

And the answer will differ from person to person.

One guy said "as long as I can eat chocolate ice-cream and watch sports on TV."

Atul Gawande's father needed more, and so his ideal treatment plan would be very different from the previous guy. The idea is that by understanding what the patient means by "good life", the doctors and the family making medical decisions know how far they can go.

This is, obviously, a difficult conversation to have with anyone. But it is a necessary conversation to have because the patient's point of view and their family's will differ. One study mentioned showed that perspective matters - if you feel the end is near, you focus more on your immediate relationships and environment. On the other hand, if you feel you've got time, you'll be more willing to delay gratification for a payoff in the future.

Being Mortal deals with a very uncomfortable subject, but it is a book that everyone should read. Even if we assume that old age is far away, an accident or illness may strike at any time, because death makes no distinction between the old and the young.

If you like podcasts, you may want to listen to Atul Gawande's Reith Lectures, and Episode 101 (Title: Minka) of Reply All, which deals with the topic of nursing homes.