Just finished Atul Gawande’s Being Mortal: Medicine and What Matters in the End. It was given to me by my mother-in-law, and we’ve had great discussions about it and end-of-life care in general as a result. It’s a good book to pass around the family. And it has opened a can of worms in the public conversation, or at least drawn our attention to the Lumbricidae that’s always around. There are a lot of interesting discussions being had (Here. Here. And here.) so I want to jump in with just a few impressions that might not show up everywhere else.
- First off, having also just finished Stephen Levine’s Who Dies? (my wife says, “It’s just going to be like this from here on, isn’t it?”), it’s a change coming to this book. There is overlap. They both make the point (Who Dies? written in 1982!) that focusing on a Heroic Battle with Death and increasing the quantity of our hours has been a particularly brutal and hubristic medical blind-alley, no matter how well originally intentioned, and that our final days and those of our people are better when met with humility. This said, Who Dies? was a useful book that speaks of Buddhism as if it’s science, while Being Mortal is a text that tips its hat to the spiritual component of the dying process, but then walks away from it, unsurprising in light of the scene at the end, beautifully written and moving, where the author spreads his father’s ashes on the Ganges with his family, and speaks of his own disconnect from Hinduism. I loved this book as both a writer and someone coming into the field, but this acknowledgement of the chaplain as “part of the hospice team” and then the role’s subsequent disappearance makes me nervous.
- The writing. This is the first book of Gawande’s I’ve read, and he has a beautiful way with words, not just “for a doctor,” but for an author. He’s using what I think of as a John McPhee structure, moving between the personal story to the history and societal underpinning of the action, and then back again, and he does it well. My favorite examples of this is his discussions of nursing homes, their creation, and some of their residents. This, however, might be because I am currently volunteering with hospice patients at an old-school nursing home and am very aware of it as an institution.
- Finally, what I really appreciate about the book–and again, this is the first of his I’ve read, so it may be part of who he is as a writer and a doctor–is the humility and honesty he brings to his work. He admits his own mistakes and the mistakes of his field, he asks questions, he tries new approaches. I pray that I always stay that flexible.
It’s been a few days since I finished, and it’s still ringing in my mind, which is always a good sign for a literary work, and I would call Being Mortal literary nonfiction. For people who are immersed in palliative care and hospice, or have a good base in alternative healing, there won’t be a lot that’s new here, but it’s well written and Gawande is an enjoyable narrator. But for those who are not in these worlds, it may be eye-opening. Or it may just confirm what you already knew in your hearts.