We all want to rely on our doctor to fix us, help us make medical decisions, and support us in stressful periods when our health, our partner’s health or our parent’s health is precarious.  In Being Mortal, Atul Gwande, a practicing surgeon and author of three bestselling books, admits that doctors often don’t do these things, explains why, and offers ideas of how doctors could help patients facing end of life decisions. Gawande explains that doctors are taught to save lives, not how to help patients live until they die. Doctors use aggressive treatment to battle death, even when they know there is little chance of the treatment affecting the final outcome for the patient.  He cites research and tells stories of his own patients and family which reveal the suffering that modern medicine can inflict on the dying process.  Gawande admits that sometimes doctors try so hard to extend life that they end up shortening it and reducing quality of life.

After he follows a hospice nurse on her rounds, observes a geriatrician in his clinic, and learns about how nursing homes could innovate to individualize care, Gawande suggests conversations that doctors, nurses, caregivers, and family members should have with frail and or terminally ill people. Gawande knows that these conversations are no easier for doctors than for family members, but when he started having these conversations with patients, he knew he was doing better by them.  A colleague of Gawande’s, a nationally recognized palliative care specialist, Susan Block, trains doctors to talk with their patients.  She suggests that each time a treatment choice needs to be made with someone whose health is deteriorating, the following questions can clarify what treatment steps to take or not take:

• What is your understanding of your situation and its potential outcomes?
• What are your fears about what lies ahead? What are your hopes?
• What kinds of trade-offs are you willing or not willing to make if the worst happens to you?
• How do you want to spend your time if your health worsens?
• Who do you want to make decisions if you can’t?

Asking these questions can lead to what Swedish doctors refer to as a “breakthrough discussion,” conversations which help sort out when someone needs to switch from fighting for time to fighting for other things they value, like being with family or taking a last trip to a beloved place, or enjoying apple pie.

In my next blog, I will discuss another theme in Gawande’s Being Mortal, where are you going to live when you need health care support? 

The timing of reading a book sometimes makes all the difference. If you are reading my blog, Atul Gawande’s Being Mortal might just be the right book at the right time for you. Gawande is an experienced surgeon who tells his professional story, a personal journey from ignorance to understanding about aging. Are you or were you a caregiver for someone you love - your husband, your wife, your mother, your father? Are you thinking about how you want to age? Are you entertaining any thoughts that you might need the care of another person as you grow older? If so, this book is a great gift to give yourself. It might help you make important health care decisions for your loved ones or yourself. It also might give you peace of mind about health care decisions you have already made for loved ones.Gawande helps the reader understand what being mortal means, through stories about his patients and research that describes the aging process.

One the themes in Being Mortal is that the process of aging and dying is normal, tragic, and inevitable. Gawande shares research that explains what happens to our bodies as we age and reach the end of life. He describes how our teeth, bones, muscles, eyes, skin, hair, hands, heart, brains and lungs decline over time. Gawande says that “the story of aging is the story of our parts.” As deficiencies in our complex bodies increase, the time comes when just one more problem is enough to weaken the whole and we become frail. If we are privledged enough to live a long life, becoming frail is a normal part of our mortality.

When we are frail, a precipitating event, like a fall, or pneumonia, may lead to death. But in our fight against old age and dying, we too often perceive an illness as a battle that must be fought resulting in a winner and a loser. Many of us don’t want to think about dying, much less talk about it or even accept that there is a 100% chance that we will all die. The very act of thinking about the possibility of our own death, and talking about it with loved ones and professionals, could help us understand our mortality, and make it a shared rather than a lonely experience.

In my next blog, I will talk about another theme in Gawande’s Being Mortal: why doctors don’t usually help us to come to terms with aging and dying, and how this could change.