Being Mortal: Medicine and What Matters at the End by Atul Gawande

cover image of Being MortalBeing Mortal by Atul Gawande is a short book that everyone should read. The author writes not only with an expertise in medicine (surgery) — as a doctor who has talked with many patients over the years — but from personal experience with family and family friends.

The awful choices that people face when given a terminal diagnosis are much more tragic when the sick person is young. The author acknowledges this, but the main focus of the book is on people who, with advancing age, are faced with choices (both for themselves and for loved ones) between what all appear to be poor options (because returning to an earlier state of health and vigor — the only really good option — isn’t an option.) Dying is a sad time, even if the dying person is 100 years old, but medical professionals’ approaches to dying tend to be institutionalized or textbook (doctor/patient), rather than time-consumingly tailored to the needs and desires of an individual who is sick or whose body is wearing out.

An excerpt from the middle of Being Mortal:

“The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.

More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, ‘You let me know when you want to stop.’ All-out treatment, we tell the incurably ill, is a train you can get off at any time — just say when. But for most patients and their families we are asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. Our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come — and escape a warehoused oblivion that few really want.” — Being Mortal, by Atul Gawande

Being Mortal is about

how to figure out what is most important to an individual at the end; how perspectives change and continue to change  as the end of life approaches;

how medical professionals can help patients make decisions when available treatments don’t exist yet, are risky, or have already failed;

how to talk with each other about what we value most;

and, most of all,  how to listen to what patients and loved ones are trying to tell us.

If you like authors like Oliver Sacks, Mary Roach, and Jane Gross, who combine science with memoir in their writing, or if you like heart-piercing memoirs like When Breath Becomes Air by Paul Kalanithi or New Life, No Instructions by Gail Caldwell, then you will probably like Being Mortal, portions of which were previously published in The New Yorker.

Being Mortal
Gawande, Atul
Henry Holt, 2014

Disclosure: I borrowed this book through the public library. It had been read many times and was already water-damaged when I received it. (Honest!)


29 thoughts on “Being Mortal: Medicine and What Matters at the End by Atul Gawande”

  1. I’ve been meaning to read this book, so maybe I’ll take my chances with my public library. I liked the excerpt you pulled; it’s a good analogy!

  2. Oh I still haven’t dared read this book, I’m afraid it’ll make me bawl. But I saw Gawande talking about this topic in a docu, about patient-doctor relationships and grief. Definitely love Sacks’ works and When Breath Becomes Air is on my tbr thanks to Deepika 🙂

  3. I didn’t expect to love a book about such a difficult topic, but I did. Gawande wrote so eloquently about his personal and professional experiences. I really hope that many people will read this book and have their thinking changed and enriched by it.

  4. This was unexpectedly fascinating! I would normally shy away from the topic, both my parents and my husband’s are gone so the only aging (or sick) people it would apply to would be us!

    1. I know what you mean. I tried to read it with myself in mind, to some extent, because distancing ourselves from the idea of our own deaths is one of the reasons we’re never prepared right up until we have no choice, I suppose!

  5. I probably should read this. I want the information for my own future (although I hope the issues are a long way off), but I suspect it will help to be grounded in it as my mother-in-law ages. And, may help with lingering doubts about what happened on my mother’s last day of life.

    1. The choices are almost always tough ones, and they keep on coming and you keep having to make more choices, which makes lingering doubts very likely in most cases, I expect. I think you would like this book!

  6. If you haven’t read When Breath Becomes Air I do highly recommend it – it goes hand in hand with Being Mortal – showing one man’s journey through all the questions and issues raised in BM.
    They are both sad at times, but so important and worthwhile and ultimately, life-affirming that I almost feel like saying that they both should be required reading for everybody, everywhere.

  7. I thought this book was so good that I reviewed it when I was only half-way through! I have never done that before. And then, of course, I posted the 2nd half of the review when I finished it. It motivated me to have a discussion with my 3 adult children about my end-of-life wishes. Although I’m only 66, I wanted them to know what I wanted. I recommend it to anybody who is advancing in age or who has elderly parents. It’s just terrific.

    1. I agree! I read your reviews, and wish I had provided more quotes from the book in mine, the way you did. I marked so many of them, but didn’t type them out to save them.

  8. I am enjoying reading all the comments on your great review. I will check this out when I log into my library account today. By the way, You ought to check out the Blogging for Book s program. You can get some good ones there. I think you’d enjoy it.

  9. Being Mortal is a great book. (And I say that not being particularly fond of either Oliver Sacks or Mary Roach!) The challenge is that I often want to recommend it to people, but I hesitate because I don’t want them to think that I’m saying they are old!

    1. I know what you mean! You don’t want people to think it’s a self-help book! I actually haven’t read anything by Mary Roach, myself, but you don’t like Oliver Sacks? Really? 😉

  10. I thought this book was outstanding and have talked about it a lot. The medical profession doesn’t handle the end of life well. As a recent example, my sister’s MIL (who had a DNR order) had a heart attack and wasn’t responding. The assisted living facility she lived in rushed her to the hospital where she was resuscitated only to be vegetative. Hospice took over and she was put on morphine and allowed to pass away peacefully. It was all handled so poorly and it didn’t need to be.

  11. I’ve read so many reviews of this one that I cannot wait to read it. I just read another medical book recently so I am thinking of waiting for a bit before I dive into this. It sounds like a powerful read.

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