August 24, 2015

Being Mortal: Review and Thoughts

For years, I've read and admired Atul Gawande, an accomplished surgeon-plus-staff writer at The New Yorker magazine. This morning, I finished reading his most recent book: Being Mortal, Medicine and What Matters in the End (2014, Metropolitan Books).

Being Mortal should be required reading. Yes, the title sounds like a downer and, yes, it doesn't have that sexy summer reading ring to it. Please know, however, that Gawande is a terrific story teller and weaves medical conditions and research findings into absorbing and deceptively entertaining chapters.

Gawande isn't telling us anything we don't already (intellectually) know about our mortality rate. It's 100%. He excels, however, by briskly and expertly guiding readers through the historical trends and philosophical perspectives, as well as the medical advancements and societal responses, that undermine how we really want to live and die.

For long-time readers of  his New Yorker articles, some of the case studies will be familiar. Now, helpfully, they are part of a larger narrative regarding family dynamics and medical professionals who, while well-trained to treat, do not know when to stop and many times equate death with failure, rather than an inevitable outcome.

What do I bring to the table as a reviewer and one who recommends this book? In no particular order, first-hand experience with:

- Elderly relatives and friends desiring, and struggling, to stay in their own homes (aging in place)
- Shopping for senior housing options, moving and selling logistics, 'heavy' lifting, culling belongings (condos, senior apartments, independent living, assisted living, long term skilled care facilities)
- Health emergencies, chronic illnesses, accidents, injuries (pharmacies, rehabilitation facilities, home health care companies, home and hospital physical therapy services)
- Routine medical specialist examinations and tests (juggling appointments, transportation, professional transport services)
- Equipment and all that goes into actually using it (canes, walkers, wheelchairs, lifts, eye glasses, hearing aids, home alert systems)
- Medications and care giving (tracking, scheduling, administering, wound care, shaving, nail care, toileting, bathing, feeding)
- Paperwork and insurance (Medicare, private insurance, private pay)
- Bill pay (phone calls, expense tracking, fighting and winning elder scams, stamina for runarounds)
- Moral support (dignity, patience, ability to listen, to laugh, to stay calm, ability to cry)

My father is currently in hospice care. My mother, his wife of 65 years, lives independently nearby. A retired nurse, she is an unflagging caregiver and loving spouse in need of support. My widowed mother-in-law survived a near-fatal heart attack two years ago. A former bookkeeper, she's lived through hospitalizations, rehabs, a major move, and multiple lifestyle adjustments.

Professionally, I've worked at social service agencies, developing policy in response to regulations and administering both private and government programs. In 2014, I was appointed to my city's senior task force. I spearhead research and recommendations regarding transportation programs that impact older residents, specifically those who can no longer drive.

In light of (because of) all these things, Being Mortal is most helpful. I've become much more aware of the why, not just the how, things are done today. How they could be done differently and that real change is happening. I'm also more aware of my own biases and fears as I encounter the avalanche of information bombarding me, my family, and my country.

As Gawande points out, there's no rehearsal for death and we must learn and pay attention before options are limited or non-existent. There is an enormous disconnect between what medical treatments can do and what we think they will do. "Our most cruel failure in how we treat the sick and aged is the failure to recognize that they have priorities beyond merely being safe and living longer."

An affirmative and necessary read, Being Mortal is unique in that it touches every single person.

"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."