Being Mortal: Illness, Medicine and what Matters in the End Summary

Atul Gawande

Being Mortal: Illness, Medicine and what Matters in the End

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Being Mortal: Illness, Medicine and what Matters in the End Summary

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Being Mortal: Medicine and What Matters in the End is a 2014 non-fiction book by American surgeon Atul Gawande. Gawande is also a writer for The New Yorker and Slate magazines, professor in the Department of Health Policy and Management at Harvard Medical School, and has published three other books on medicine: Complications, Better, and The Checklist Manifesto. One of Gawande’s articles, “The Cost Conundrum,” on the quality of healthcare, gained political importance in 2009 when it was cited by former President Barack Obama as evidence of necessary reforms to the rising costs of unnecessary healthcare. His first book, Complications: A Surgeon’s Notes on an Imperfect Science (2002) candidly discusses the limits of modern medical knowledge and its practitioners. In the follow-up, titled Better: A Surgeon’s Notes on Performance (2007), Gawande discussed the three most important virtues in medicine: diligence, doing right, and ingenuity. His third book, The Checklist Manifesto: How to Get Things Right (2009), discusses the importance of preparation and planning through checklists both in medicine and in the outside world. Being Mortal is his most recent publication, investigating the conflict between the medical goals of extending life and end-of-life care. It served as the basis for the 2015 PBS documentary Frontline.

Being Mortal is comprised of an introduction, eight chapters and an epilogue. Two of the chapters, “Things Fall Apart” and “Letting Go,” are actually transpositions of two of his most famous New Yorker articles. One of the techniques Gawande uses in all of his writing is to intersperse first-hand narratives of various medical procedures and interviews in order to give fuller and more varied insight into the medical community. In this case, Gawande begins with a story about his father, also a surgeon, who discovered he had a tumor growing inside his spinal cord. This left him with two possibilities: to have a risky and possibly debilitating surgery to have it removed, like his doctor had recommended, or to leave it until the risks of the surgery were outweighed by the risks of the tumor. This leads Gawande into his meditation on the true goals of healthcare, especially in the cases of geriatrics, serious illnesses, and approaching death. Gawande says that for most healthcare professionals—himself included—the goal has wrongly been extending life and survival when it should really be to “enable well-being.”

Gawande argues that by focusing on disease rather than on life, modern medicine has been slow to confront the reality of the decline of life and to reckon with its purpose there. In the first part of the book Gawande examines different modes of senior care. By way of example, Gawande points out that 97% of medical students never take a class in geriatrics; as a result, there are many instances in which the quality of life of the elderly comes second to keeping them alive. In the second half of the book Gawande shifts somewhat to discuss end-of-life medicine, again asking what we give up in order to extend life. Moreover, what is the quality of the life we are seeking to extend? Gawande cites a 2008 study published by the national Coping with Cancer Project, which found that patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or who were admitted into intensive care experienced a significantly worse quality of life in their last week than patients who received no such interventions. The caregivers of the patients receiving these interventions were also six times more likely to suffer major depression. It is the questionable effectiveness of these procedures, along with their substantial cost, that leads Gawande to his conclusion that medical professionals need more training in discussing and accepting death as an inherent by-product of life.