Book Review: Being Mortal Illness, Medicine and What Matters in the End by Atul Gawande

Atul Gwande is an American Surgeon, writer, for the New Yorker and a public health researcher. He practices general and endocrine surgery.  He has written four New York Times best sellers the most recent of which is Being Mortal: Illness, Medicine and What Matters in the End.

Being Mortal had been brought to may attention some time ago at an end of life conference I attended and I have since heard it talked about it palliative care circles and it seemed like something I should read. After I completed this book, with a sigh of relief (yesterday!), I tweeted that this wasn’t an easy read, although fairly essential for anyone working in oncology, elderly care or palliative care.

This book is split broadly into two halves.  The first focuses on how we care for people in an ageing population when they can no longer care for themselves, particularly  in their own homes.  Grande gives many examples of those who have benefited from innovative care centres and care that moves away from the standard care given in many nursing homes  and care centres world wide.  The second part of the book and the part that I found most interesting focused on how we care for people who have an illness which is not curable and the approach given in medicine and nursing to palliative and end of life care.

“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 person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.”

This book made me both nod madly in agreement and cringe in equal measure.  I cringed because as a provider of healthcare to those who are dying myself, so much of what I read is what I see happening in our hospitals and community practices every day. We don’t allow people to die.  And when we do, for many, this is seen as some kind of failure. Even when that death is a release from the pain and misery of relentless and often futile treatment.  Treatment  may prolong life temporarily, but at what cost and in what form.  However, I also know (and this is where the mad nodding happened) that much of what Atul talks about does happen.  There are many dedicated healthcare professionals, and not just in palliative care, who do believe in quality and comfort.  Who try daily to make sensible decisions with and for their patients.  Who give their patients the time to talk about the future and what they might want from that when treatment no longer works and time is clearly very limited.

Atal writes passionately not just as a doctor but as a son whose father died from a  tumour of the spine.  He approaches the subject personally.  He acknowledges the need for timely, honest communication with patients  about what they want.  He also recognises that the  hardest thing for many physicians is being brave enough to do ‘nothing’.   I would agree with this but would also say that doing nothing in terms of treatment is actually doing something very active, when that nothing involves quality time to spend with loved ones, good symptom control and putting the ‘patient’ back in control.  This book also illustrates how much pressure doctors come under from patients who expect that there will always be treatment available and death will never come.   Just today I heard a family say “this is 2016, you must be able to do something”.  Sometimes to do ‘nothing’ does indeed take immense courage

So I would say do read this book.  It may make you despair, but it may also make you think sensibly about your own future or the future of those you love.  For one thing is certain, we are all mortal.

Image, Changing Pages

If you enjoy all things of a literary nature you can find this post and many more beside on the Literacy Monday Musings hosted by Pages and Margins blog.  Do have a look .