I was surprised to see Being Mortal: Medicine and What Matters in the End near the top of the New York Times nonfiction bestseller list – not because it’s not an excellent book (which it is), but because the subject matter is not, shall we say, easily approachable. (Discussions about death and dying rarely are.)
Then I thought of the number of Baby Boomers now struggling for answers as they deal with aging and incapacitated parents, looking for pathways to follow as they wrestle with an issue deeply affecting their own lives, and it’s no wonder Being Mortal strikes such a major chord.
Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston who’s also a staff writer at The New Yorker and author of three books – one of which, Complications, was a finalist for the National Book Award – sets about the task of exploring the great dichotomy of how modern medicine, in its effort to extend lives, is often oblivious to the wide-ranging ramifications that impact the quality of those lives.
“People live longer and better than at any time in history,” Gawande writes. “But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical world have proved alarmingly unprepared for it.”
In the introduction, Gawande points out the fact that as late as 1945, the majority of people died in their homes; by the 1980s, that number was just 17 percent. The subsequent shift to hospitals and nursing homes as the epicenters of care for aging patients, the challenges that have emerged for the field of geriatrics as the population lives longer and longer, and the choices that the ill and the elderly (and their loved ones) must eventually confront are the primary focuses of Being Mortal.
Balancing well-crafted research with insightful windows into the human dimension, Gawande comes up with an analysis that is both thought-provoking and wonderfully written, without any of the dryness or distance that might be expected from a member of the medical profession. Illustrative stories, such as that of his grandmother-in-law, Alice, whose physical and mental decline are rendered in heartbreaking detail, comprise a large segment of the book.
Enlightening, also, are discussions of groundbreaking approaches that have contributed to the evolution of later-life care, such as assisted living facilities and projects aimed at improving the nursing-home environment for seniors. One such program was initiated in 1991 by a young doctor named Bill Thomas, whose idea of adding animals as well as plants and flower gardens at a home in New Berlin, New York resulted in a significant drop in the death rate there. (“The most important finding of Thomas’s experiment wasn’t that having a reason to live could reduce death rates for the disabled elderly,” Gawande notes. “The most important finding was that it is possible to provide them with reasons to live, period.”)
Hospice care is also explored as an often-overlooked but growing alternative for those with terminal conditions. An interesting approach was launched by the insurance giant Aetna in 2004. Generally, hospice requires an agreement on the part of the patient to accept only palliative care for their illness, but Aetna allowed the pursuit of treatment options while at the same time having a hospice team to assist at home. Enrolled patients in the so-called “concurrent care” program ended up visiting the ER half as often as the control patients, use of hospitals and ICUs fell by more than two-thirds, and overall costs dropped by almost a quarter.
The phenomenal success of the program was stupefying. “What was going on here?” asks Gawande. “The program’s leaders had the impression that they had simply given seriously ill patients someone experienced and knowledgeable to talk to about their daily concerns. Somehow that was enough – just talking.” It’s another example that buttresses the book’s theory that simple avenues of emotional support often matter more than complicated medical interventions at the end of life.
Gawande’s own experience with his father, whose illness brought the author face to face with many of the same scenarios encountered by the patients he talks about in the book, culminates in a haunting epilogue about returning his remains to his homeland of India, ashes scattered along the Ganges River. “In bringing us there, my father had helped us see that he was part of a story going back thousands of years – and so were we,” writes his son.
In its own way, Being Mortal is also a powerful testament to the timeless truth of that thought.