Few doctors in the modern era have established themselves so securely as both doctor and writer as to be easily recognized in both circles; this is perhaps because of the difficult and time-demanding nature of both careers. One notable exception is Dr. Atul Gawande, a renowned general surgeon in Boston, MA, who also happens to be a widely published and well-known author of several books. In his most recent book, Being Mortal, it is clear that he has grown, not only as a writer, but as a doctor and a human being as well — which, after all, is what this book is all about.
Gawande brings his clear thinking and straightforward, conversational writing style to the topic of being mortal — “medicine and what matters in the end.” He covers a wide variety of subtopics throughout the book: aging, dying, assisted living facilities and nursing homes, hospitals, hospice and family and patient struggles with letting go. His musings on these topics are part philosophical and part scientific, and his desires to think deeply about the world and to use the right words are obvious as he explores each topic.
Woven seamlessly through Gawande’s musings are anecdotes that bring the ideas fully to life. His ability to accurately characterize a patient — by letting his patients’ personalities be the main focus of his writing — shines through in Being Mortal. It is clear that it was only through encounters with real patients and their stories that made the lessons about the end of life become fully real for him. The same is true of the reader as Gawande quite beautifully demonstrates each of his points with a patient who embodies it. The people represented in this book vary; some are Gawande’s own patients, some are patients he interviewed for the book and some are close to him personally — including a powerful story about his own father.
In his simple, elegant writing style, the author shares some incredibly profound thoughts that this reader, at least, needed to hear, and I contend that his words are important enough for anyone to gain insights. In regards to his journey with various patients, including his father, he talks about how difficult it still was for him to grasp what was important about the dying process: “Only now [after a long time already involved in the process] did I begin to recognize how understanding the finitude of one’s time could be a gift.” This quote highlights a central theme of the book — a theme that was, I think, a combination of personal realization and the result of scientific study. The theme is that humans are not good at comprehending their own mortality, in general, but once they are faced with it, their values tend to shift radically. At the end of life, people care less about money, about success and about building a legacy. Instead, they care more about life’s simplicities: the beauty of a garden, the taste of good food, the sound of a friend’s voice.
This theme may not be overwhelmingly surprising — after all, one of Hollywood’s favorite motifs is “you have to find out you’re dying to truly live.” Even so, Being Mortal approaches it differently. This book is not just about pursuing values and discovering what is really important. Instead, it is about the process itself — dying — and what that process does for patients, doctors and families. Medicine, by default, has often sought to prolong lives without regard for a patient’s quality of life; Gawande suggests a better way. He argues that by having the difficult conversations with a patient and helping the patient clarify his or her values, we can improve the quality of this person’s life for today — and that this will ultimately help patients live better, yes, but also die better. The simple act of helping a person sort out his or her own values often heals the patient in ways that “modern medicine” never could.
Conversations of dying and quality of life are hard conversations. Gawande knows this — I suspect it was a major reason he wrote this book. Being Mortal makes significant strides in destigmatizing these conversations. As he writes about his experiences with dying, it is clear that only in recent years has his own perspective changed. He talks about experiences in medical school, with built-in aspects of the curriculum that were designed to get medical students thinking about these issues. Most of us can relate to this; these classes on humanism and ethics are often sources of frustration for medical students. His experience was similar, but through reflection and years of clinical practice, he realized the importance of these conversations. A major lesson for medical students in this book, then, is to start thinking and talking about these issues early in their education. By dealing with issues of mortality throughout medical school, students can get a head start on learning how to navigate the clinical nuances of dealing with patients who are dying.
I highly recommend this book for all medical students — and for all doctors and patients. In addition to the thoughtful sentiments and profound ideas about mortality presented in this book, it is a worthwhile read because Gawande models for us how to treat patients. Atul Gawande the writer is inseparable from Atul Gawande the surgeon, which makes the book even better — he is able to intersperse his broad knowledge of medicine throughout his discussion. His brief vignettes about medical schools and their failure to teach students about dying carry much weight for current students. This has led, he contends, to modern medicine being unprepared to talk to patients about dying. Although this book won’t necessarily solve that problem, it’s a wonderful place to start.
Prints, Pages and Pagers aims to look closely at the lives of medical students and doctors, real or fiction, whose lives and experiences are told in novels, short stories, poetry or any kind of writing. These book reviews are an opportunity for medical students to learn from the many fascinating stories produced by the field of medicine, and maybe to read something other than a textbook.