Life Changing

32 reviews

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

Published: 2014-10-07
Hardcover : 304 pages
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In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to ...

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In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

Editorial Review

An Amazon Best Book of the Month, October 2014: True or false: Modern medicine is a miracle that has transformed all of our lives.

If you said “true,” you’d be right, of course, but that’s a statement that demands an asterisk, a “but.” “We’ve been wrong about what our job is in medicine,” writes Atul Gawande, a surgeon (at Brigham and Women’s Hospital in Boston) and a writer (at the New Yorker). “We think. . .[it] is to ensure health and survival. But really. . .it is to enable well-being. And well-being is about the reasons one wishes to be alive.” Through interviews with doctors, stories from and about health care providers (such as the woman who pioneered the notion of “assisted living” for the elderly)—and eventually, by way of the story of his own father’s dying, Gawande examines the cracks in the system of health care to the aged (i.e. 97 percent of medical students take no course in geriatrics) and to the seriously ill who might have different needs and expectations than the ones family members predict. (One striking example: the terminally ill former professor who told his daughter that “quality of life” for him meant the ongoing ability to enjoy chocolate ice cream and watch football on TV. If medical treatments might remove those pleasures, well, then, he wasn’t sure he would submit to such treatments.) Doctors don’t listen, Gawande suggests—or, more accurately, they don’t know what to listen for. (Gawande includes examples of his own failings in this area.) Besides, they’ve been trained to want to find cures, attack problems—to win. But victory doesn’t look the same to everyone, he asserts. Yes, “death is the enemy,” he writes. “But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee... someone who knows how to fight for territory that can be won and how to surrender it when it can’t.” In his compassionate, learned way, Gawande shows all of us—doctors included—how mortality must be faced, with both heart and mind. – Sara Nelson


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Discussion Questions

1. Why do we assume we will know how to empathize and comfort those in end-of-life stages? How prepared do you feel to do and say the right thing when that time comes for someone in your life?

2. What do you think the author means when he says that we’ve “medicalized mortality”? How does The
Death of Ivan Ilyich
illustrate the suffering that can result? Have you ever witnessed such suffering?

3. As a child, what did you observe about the aging process? How was mortality discussed in your family? How do your family’s lifespan stories compare to those in the book?

4. Have you ever seen anyone die? What was it like? How did the experience affect your wishes for the end of your own life?

5. What surprising facts did you discover about the physiology of aging? Did Dr. Gawande’s descriptions of the body’s natural transitions make you more or less determined to try to reverse the aging process?

6. Did you read Alice Hobson’s story as an inspiring one, or as a cautionary tale?

7. Do you know couples like Felix and Bella? The last days for Bella were so hard on Felix, but do you think he’d have had it any other way? Was there anything more others could have done for this couple?

8. Chapter 4 describes the birth of the assisted-living facility concept (Park Place), designed by Keren Wilson to provide her disabled mother, Jessie, with caregivers who would not restrict her freedom. Key components included having her own thermostat, her own schedule, her own furniture, and a lock on the door. What does it mean to you to treat someone with serious in rmities as a person and not a patient?

9. What realities are captured in the story of Lou Sanders and his daughter, Shelley, regarding home care? What con icts did Shelley face between her intentions and the practical needs of the family and herself? What does the book illustrate about the universal nature of this struggle in families around the globe?

10. Reading about Bill Thomas’s Eden Alternative in chapter 5, what came to mind when he outlined the Three Plagues of nursing home existence: boredom, loneliness, and helplessness? What do you think matters most when you envision eldercare?

11. How would you answer the question Gawande raises in chapter 6 regarding Sara Monopoli’s nal days: “What do we want Sara and her doctors to do now?”

12. The author writes, “It is not death that the very old tell me they fear. It is what happens short of death...” (55)
What do you fear most about the end of life? How do you think your family would react if you told them, “I’m ready”? How do we strike a balance between fear and hope, while still confronting reality?

13. In Josiah Royce’s book, The Philosophy of Loyalty, he explores the reasons why just food, safety, shelter, etc. provide an empty existence. He concludes that we all need a cause beyond ourselves. Do you agree? What are your causes? Do you nd them changing as you get older?

14. Often medical treatments do not work. Yet our society seems to favor attempts to “ x” health problems, no matter the odds of their success. Dr. Gawande quotes statistics that show 25% of Medicare spending goes to the 5% of patients in the last stages of life. Why do you think it’s so dif cult for doctors and/or families to refuse or curtail treatment? How should priorities be set?

15. What is your attitude, as you put it into practice, toward old age? Is it something to deny or avoid, or a stage of life to be honored? Do you think most people are in denial about their own aging?

16. Discuss the often-politicized end-of-life questions raised in the closing chapters of Being Mortal. If you had to make a choice for a loved one between ICU and hospice, what would you most want to know from them? Susan Block’s father said he’d be willing to go through a lot as long as he was able to still “eat chocolate ice cream and watch football on television.” What would you be willing to endure and what would you not be willing to endure for the possibility of more time?

17. As the author learns the limitations of being Dr. Informative, how did your perception of doctors and what you want from them change? What would you want from your doctor if you faced a serious illness?

18. Doctors, and probably the rest of us, tend to de ne themselves by their successes, not their failures. Is this true in your life? At work, in your family, at whatever skills you have? Should we de ne ourselves more by our failures? Do you know people who de ne themselves by their failures? (Are they fun to be with?) How can doctors, and the rest of us, strike a balance?

19. In chapter 8, Dr. Gawande describes the choices made by his daughter’s piano teacher, Peg Bachelder. Her de nition of a good day meant returning to teaching, culminating in two concerts performed by her students. If you were facing similar circumstances, what would your good day look like?

20. How was your reading affected by the book’s nal scene, as Dr. Gawande ful lls his father’s wishes? How do tradition and spirituality in uence your concept of what it means to be mortal?

Suggested by Members

1. How did the writing style contribute to the intent of the book? Did the author succeed in keeping you engaged?
2. What new concepts did you learn from the book? Any surprises? What did the author say that he had learned about end of life issues?
3. How does this book relate to your own past, current or future life experiences?
by MGINFM (see profile) 05/05/15

Notes From the Author to the Bookclub

No notes at this time.

Book Club Recommendations

Three words
by BittyBella (see profile) 02/20/17
We started by having members put the three words or phases they thought best described the book/content on the board and then discussed the many view points and topics.

Member Reviews

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by dorenejorgensen@gmail.com (see profile) 06/27/17

by PCrouch (see profile) 04/19/17

by sdezelle@hotmail.com (see profile) 04/19/17

by JooCho (see profile) 03/08/17

by BBednarek (see profile) 03/02/17

  "Being Mortal Medicine and What Matters in the End"by BittyBella (see profile) 02/20/17

A book that will generate much discussion.

  "Being Mortal"by jmlyons3 (see profile) 02/04/17

A great read for Baby Boomer age readers on the realistic end of life decisions. Great discussion on what to do as parents age and die and facing our own mortality.

by bloomm (see profile) 01/19/17

by rmjjj (see profile) 12/23/16

  "Everyone should read!"by STeleki (see profile) 08/27/16

We are all mortal. You will face these issues one way or another for your parents, yourself.

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