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Review: Facing up to Mortality in the Modern World

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

This is a book about our modern experience of mortality. It is full of stories that can inspire us to change the way we consider growing old; how to make life worth living and face the reality of decline and death. In a pandemic, which impacts the elderly in particular and brings mortality to the fore, this is a helpful reminder of what is important in life.

Atul Gawande, is a surgeon and writer, based in Boston, America. He writes powerfully, telling well researched stories about real people and situations. He starts with Mr Lazaroff. A man with terminal cancer who opts for an operation that will not save him or improve his quality of life. He dies a prolonged and terrible death because he and the medical staff could not face the reality of the fact that he was dying. Months of treatment but no discussion about the larger truth of his condition and the limits of medicine. No discussion about his anxieties, what might matter and be important to him near the end of life.

Gwande tells us about his wife’s grandmother Alice, her spirited and independent life; determined to continue living on her own. Then contrasts that with his own grandfather Sitaram, who at over 100 years old lives with his extended family in India. Independent living is great until the point comes when sooner or later it is no longer possible. The story of a relatively fit 85-year-old Jean attending a geriatric clinic is interesting. Never mind the obvious health ailments, it is about the underlying risk of falling that concerned the examining consultant. Each year hundreds of thousands of elderly people fall and break their hip, with life threatening consequences. Who cares for our feet when we can’t? The stories follow the decline of human health and tackles the hard questions about the limits of modern medicine in cancer treatment.

Gawande is on a mission to improve the provision of care in nursing homes, from prison-like institutions with their over-concern for the safety of residents, to places where life is enhanced. He tells the story of a new nursing home director battling against the rules to bring life into the home. Two dogs, four cats, 100 parakeets, rabbits, hens, plenty of indoor plants and children visiting, transform the place.

What is important? What gives life, even at the end of life? How do we move from a culture of seeking to rescue people from death, to one where there is acceptance, where the question is asked about what matters? Gawande’s book is a thoroughbred; one of the best books I’ve read in recent years. Not easy, but it shows us what can be done with compassion, innovation and a willingness to face our own mortality.

Review by Canon Mike D Williams