We All Die, So Why Don’t We Die Well?

Rachel GaiMay 11, 2021Life and DeathMedia

Never would I imagine myself reading a book with the word “medicine” in the title, but once I picked up Dr. Atul Gawande’s Being Mortal: Medicine and What Matters in the End, I found myself captivated by the compelling stories, eye-opening research, and modern medical issues.

As a medical student, Gawande was only taught technical and procedural skills, never the skill of sympathizing with patients and attending to their personal needs. To make up for this, he explores how the modern experience of morality has evolved, and how we can better approach the experience of aging and dying by tackling issues like patient care in nursing homes and end-of-life treatments in hospitals.

The book starts off by introducing the independent self, which looks at a classification system for the levels of function; basically, if you cannot, without assistance, perform independent tasks like eating, dressing, bathing, and so on, then you lack the capacity for basic independence. By introducing levels of physical independence, the first chapter touches on the Western phenomenon of spending old age under a medical regime in comparison to other countries; to show this, Gawande uses his grandfather in India as an example of an elder who receives care from family members instead of being sent into the unknown environments of nursing homes. Especially when we’re at our weakest, we need assurance that the people we most care about are by our side. However, not wanting to burden family or friends poses a paradoxical challenge for elders. Thus, when the elderly can no longer rely on extended family, they are left with a controlled and supervised institutional existence, a medically designed answer to unfixable problems – a life created to be safe but empty of anything they care about.

The idea of old age evolves as life expectancy increases due to technological improvements. The rapidly advancing field of medicine is increasing longevity, but is this really good news? We humans naturally avoid the subject of decrepitude – no one wants to experience the setbacks caused by aging – and so we immediately turn to doctors and medicine for guidance. However, according to Gawande “the job of any doctor . . . is to support quality of life, [meaning] two things: as much freedom from the ravages of disease as possible and the retention of enough function for active engagement in the world.” Thus a doctor finishes their job once they prescribe patients medication or treat whatever disease once limited the patient’s actions.

In the following chapter, “Dependence,” a tear-jerking story of an elderly couple, Felix and Bella Silverstone, portrays the restrictions of nursing homes. Not long after Felix saw how the nursing staff at Bella’s nursing home unit would treat her, he demanded to take her home and care for her alone instead. This would soon be the best decision of his life, as Bella passed away four days later, leaving Felix feeling empty but assured that their last days together were spent in each other’s warmth. As one of my favorite anecdotes in the entire book, this story shed light on elders who must restrict themselves within the limitations of nursing homes by sacrificing freedom and things they value. While care in nursing homes has evolved, there are still many that fail to figure out what patients truly want, and most importantly, how to make their last years worth living. In conclusion, nursing homes should go the extra mile to include that “home” aspect by generating beautiful memories without endangering the little time that is left for many patients.

After touching on how society’s avoidance of the final phase of the human cycle results in controlling institutions, the book shifts toward finding a better alternative to nursing homes by introducing the concept of assisted living and hospice care. Ordinary people should be able to age without having to choose between neglect and institutionalization, but in the past, this was not the goal. Gawande points out how “the sociologist Erving Goffman noted the likeness between prisons and nursing homes half a century ago in his book Asylums." These instances are often a result of legal restrictions imposed upon care homes to design a life with safety but also with emptiness.

Finally, in the epilogue, Gawande brings up once again how palliative care can help people obtain the end of life they want. He reminds us that medicine cannot cure death – nothing can, as it is an inevitable consequence of living. Therefore, we must prevent ourselves from treating aging as a medical experiment by prolonging life, and instead, improve the quality of aging by averting some of its negative effects.

Gawande brings to life the issues facing modern medicine and uses heart-gripping stories of families torn apart and elders being stripped of their freedom to answer the questions “What matters in the end?” and “How we can achieve what we truly want at the end of our lives?” I give Being Mortal a solid four out of five stars for its remarkable teachings as it zooms in on modern trends impacting mortality – especially ones that I’ve never considered before. Although the book makes several crucial points about future medical developments, I would often come across unknown medical terms that got in the way of fully understanding Gawande’s ideas. While this wasn’t a big problem, the book would have been more enjoyable if I were experienced in the medical field, as Gawande often uses a professional and informative tone, making many parts come off as extraneous. Additionally, I wish Gawande would have included ways we, as normal citizens, could prevent these medical problems from happening in the future.

Overall, I recommend Being Mortal for anyone who intends on living a good life up to the very end. No matter your age, you will dive deep into life lessons about, well, living. Though it may seem intimidating at first to read about mortality and confronting death, rest assured, as this book will broaden your horizons on several themes including society’s destigmatization of death and illness, the evolution of end-of-life care, and achieving autonomy and self-fulfillment at the end of life.

Rachel Gai is a junior who lives in Houston, Texas. Besides writing, she loves dancing, photography, art, and learning about filmmaking.