Being Mortal by Atul Gawande is the kind of book I would have bypassed on a shelf a year ago.
And here we are. The year is 2020 and I devoured this book in less than a week. Not just that – within the first 100 pages, I’d decided it was one of the best nonfiction books I’ve read in ages.
The reasons for my lack of interest might have been plentiful. The cover looks too plain, a nonfiction read on medicine and science didn’t fit in with my usual desire for excitement and adventure. Et cetera.
What prompted me to pick this one up?
It came recommended on the topic of aging parents. Despite Covid and the world going crazy in 10 other ways this year (hello, 2020), life has a way of going on.
And go on it did. Just a few weeks ago I helped a loved one move into an assisted living residence. It was a new experience for me, one that piqued a lot of questions in my mind. Being Mortal answered these questions, and then some (before I’d even thought to ask them).
We are all going to die. When I was a kid, that didn’t sound like a great option to me, so I hoped I would luck out like Moses and get to skip that part. But if that’s not an option, Being Mortal examines a topic that is a disservice to avoid: the decline of a human’s final years and how to best handle it.
Geratric care
Atul Gawande’s affable, easy-to-read writing style drew me in instantly. He avoided getting overly technical while employing storytelling to get his most poignant points across.
I particularly enjoyed reading about Felix Silverstone, who had been a national leader in geriatrics for half a century. He retired at 82 to help care for his wife of 60 years. That meant giving up his practice and moving into a retirement community that offered independent living with an upgrade option to assisted living when the time came.
Felix described his increasing physical and mental limitations. By steering a health care services committee and mentoring other doctors, he created purpose beyond his professional career. He credited this purpose with helping him stave off minor depression.
Through Felix’s story, Gawande delves into the importance of geriatric medicine – and, unfortunately, how undervalued it is. Consequently, the American healthcare system is understaffed in geriatric medicine.
Fewer than 300 doctors in the United States complete geriatrics training every year, which won’t be enough to meet the demands of the next decade. The problem is worse, not better, in most other countries.
“We do not like to think about this eventuality,” Gawande writes, in reference to aging and the eventual need for geriatric care that most of us might need. “Most of us are unprepared for it.
We rarely pay more than glancing attention to how we will live when we need help until it’s much too late to do much about it.”
Living arrangements
Gawande also provides some helpful backstory on the living arrangements we employ for our older loved ones. Nursing homes began as a solution to clear the elderly from hospitals and free up hospital beds. They replaced the “poorhouse” (yes, they really did exist), which is where those who were aging and couldn’t afford private care basically went to live out their final days in a cold, prison-like existence.
Assisted living homes began as an Oregon experiment in the 1980s. The surging demand helped the concept gain traction in the 90s. By the early 2000s, assisted living exploded in popularity.
As I’m personally aware, elders in many cultures expect to live with their families. They would completely balk at the idea of being cared for by paid strangers. Gawande illustrates the hardships faced by families who decide to take this route with the story of Shelley and her father Lou.
Lou kept Shelley and her family up with his night terrors, refused to bathe when his hired home health aide was present to help him, and required constant transportation to see various medical specialists. At one point, Shelley had to cut a vacation short to come home and attend to him.
When her husband tried to assuage her by saying, “How much more time is there?” it turned out that they had another three years with Lou before they turned to an alternative living solution.
A personal ending
Although he does an excellent job illustrating how modern medicine has affected the lives of several patients, Gawande finishes strong by telling a more personal story in the book’s final pages – that of his father’s gentle, calculated decline and eventual passing. The way he tells this story never feels sappy or overdone, just tinged with wisdom and a bit of wistfulness.
Both of Gawande’s parents were doctors – as he puts it, they have 120 years of medical experience between them. This put his father in a unique position to weigh the pros and cons of proceeding with surgery to remove a spinal tumor.
Rather than taking immediate action as one of his surgeons pushed him to do, he chose to make gradual adjustments to his life around his condition. While his decline was gradual, it wasn’t without its struggles.
At this point in the book, Gawande creates a platform for hospice and palliative care (the latter of which I had not been familiar with). Like geratric care, these two provide holistic services that are more concerned with the patient’s quality of life than most specialized medical procedures.
His father’s decline wasn’t without its struggles. In one particular passage, he is asked to swallow his pride and try to get around without help. Gawande writes, “After that, he had no more falls, and we gradually realized how much each one had set him back.”
The story ends in India, where Gawande goes to spread his father’s ashes in the Ganges river. He describes the peace he felt in those moments and the warmth of the sun on his face. Then he turns to head back into the bustling rush of life. Cue Celine Dion’s “Then You Look At Me” and maybe a tear.
The final few paragraphs served as an always-useful reminder that life is a temporary state, and that we are doing ourselves and our loved ones a disservice by avoiding conversations about our final chapters.
Leave a Reply