It is possible to savor every moving anecdote, graceful paragraph and astute observation in “Being Mortal,” the latest book by surgeon/writer Dr. Atul Gawande, and still find yourself wanting to pose a few impatient questions to the author.
“This comes as news to you? Were you not paying attention?”
Subtitled “Medicine and What Matters in the End,” the book skillfully maps out the quandaries facing both health care professionals and patients and their families when they come up against the limits of contemporary medicine at the end of life.
As a newly minted physician, “I knew theoretically that my patients could die, of course, but every actual instance seemed like a violation, as if the rules I thought we were playing by were broken,” he acknowledges. “I don’t know what game I thought this was, but in it we always won.”
By now, though, Dr. Gawande has come to understand this territory well. He has seen his grandmother-in-law falter and die; he has helped his once unstoppable father enter hospice care. He has worked with many patients, young and old, whose diseases and disabilities can’t be fixed, though that generally doesn’t stop them or their doctors from trying.
In his hospital and in his life, he sees the evasion of discouraging realities, the pressure to do something when just standing there might be more helpful, the conveyor belt that carries ailing patients and their hopeful loved ones from emergency room to hospital bed to nursing home when staying home is what almost everyone claims to want.
He passes all this along, laced with relevant research findings. He visits nursing homes and geriatricians’ offices and tags along with a hospice nurse. He also explains the medical, financial and other systemic factors that shape our sometimes limited choices.
It is a “modern tragedy,” Dr. Gawande writes: “When there is no way of knowing exactly how long our skeins will run — and when we imagine ourselves to have much more time than we do — our every impulse is to fight, to die with chemo in our veins or a tube in our throats or fresh sutures in our flesh.
“The fact that we may be shortening or worsening the time we have left hardly seems to register. We imagine that we can wait until the doctors tell us that there is nothing more they can do. But rarely is there nothing more that doctors can do.”
And rarely do doctors write so eloquently. But if you have been reading other books and articles about aging and dying, if you have grappled with these issues on behalf of dying relatives yourself, you may not find much in “Being Mortal” that you haven’t already learned.
In fact, Dr. Gawande surprised me — though this may be a narrative strategy, a way to engage readers in his discoveries — with his apparent willingness to not look squarely at these issues for much of his career.
In a chapter called “Things Fall Apart,” partly devoted to geriatrics and its benefits, he notes that he’s passed his own hospital’s geriatrics clinic daily for years, “and I can’t remember giving it a moment’s thought.”
He hadn’t thought much about hospice, either, and knew few patients who chose it until they were days from death. It is an odd oversight, now that more than 40 percent of American deaths involve hospice. But if, as he writes, “the picture I had of hospice was of a morphine drip,” why would his patients grasp its multiple benefits and enroll earlier?
Don’t misunderstand: “Being Mortal” is a wise and potent conversion tale, and I hope it draws a huge readership. (It makes its debut on the Oct. 26 New York Times Bestseller List at number three in hardcover nonfiction, and the publisher has already gone back to press three times — so it is on its way.)
That other physicians, authors, researchers and advocates — Ira Byock, Katy Butler, Dennis McCullough, John Sloan — have surveyed the same landscape doesn’t diminish Dr. Gawande’s book. These are arguments that can’t be made too often, and they are not often made this well.
Medicine and What Matters in the End.
By Atul Gawande, M.D.
Metropolitan Books. 282 pages. $26.Credit Alessandra Montalto/The New York Times
But the real power of “Being Mortal” might come from the mere fact of Dr. Atul Gawande — a writer at The New Yorker, certified MacArthur Foundation “genius”, prize-winning and already best-selling author with 101,000 Twitter followers — having written it.
He has a bigger megaphone than most of his predecessors. Last week, Dr. Gawande was all over PBS and public radio, and chatted with Jon Stewart. Stay tuned for a “Frontline” documentary based on the book in January, too.
People who didn’t pay attention before may listen up now.
Related Article
From Science Times: Don’t Spoil the Ending (Oct. 6, 2014)
Books of The Times: A Prescription for Life’s Final Stretch (Oct. 16, 2014)
An earlier version of this post misidentified a relative of Dr. Gawande who had died. She was his grandmother-in-law, not his mother-in-law.