Amazon.com: Customer reviews: Being Mortal: Medicine and What Matters in the End

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The Old and Sick Are Not Children

Reviewed in the United States on May 26, 2016

This is a timely book for me because my parents are very elderly (94 and 88) and determined to stay in their home until the last possible second. After reading this thought provoking book that teaches so much I am thinking that it may be possible for them to stay until the end which could be next week or a few years from now. It's going to take some organizing, but it looks like it is worth some research and time. It makes me sad to see how much of their independence they have lost, but they still enjoy their lives as limited as they are.

There is a tendency to treat old people like children which I realize now is usually very wrong. My dad is a diabetic and we (my siblings and I) have told him over and over that his diet of sugary cereal or cinnamon rolls and orange juice for breakfast and light store brand fruit yogurt with grapes and three cookies for lunch is not what he should be eating. He acts surprised every time we mention this, but doesn't change a thing because I now understand that he wants the independence of eating as he pleases. He has lost so much--can barely hear or see or walk, that he needs these very small pleasures to continue. I imagine he doesn't see the point in giving up anything else because he has so little left. My mother's memory is going and she has COPD, but somehow has lots of get up and go. She does a lot for my dad even though I suspect she is the sicker one. Being Mortal is making me think about the best way to help my parents which will probably start with asking them what they want.

One thing that surprised me completely was Dr. Gawande's statement that genetics is only a small part of reaching old age. Here I've been thinking that because my parents have lived so long that reaching old age is probably a no brainer for me. I have to think about that possiblity some more--a lot more.

This book has some touching stories about very sick people and how their lives ended. Unfortunately for many sick people the medical community is driven to act, but not necessarily to do what is best for the individual. It seems to me that they've forgotten "the do no harm" part of being a doctor. It seems to me it does harm people to ruin the time sick people have left.

A very through provoking book that will ultimately make me think about what I want when the end is near. I wish everyone would read it; especially medical people.

497 people found this helpful

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Margaret N. Flannery

Somethings to Consider toward the End

Reviewed in the United States on November 6, 2015

Book is mostly well written. It is about death and dying, so be prepared to read it when one is in a good frame of mind. It profiles patients who are terminal and how they and their families coped with the specter of death. Doctor Gawande relates the stories of courageous patients nearing the end of their lives. Bear in mind, they are upper middle class, obviously have means at their disposal and even though their prospects are bleak. I wondered what people who do not have the luxury of good insurance and top-notch medical care experience at the end of their lives. Perhaps it is better, not going through the excruciating treatments, frequent hospital stays and non-stop tests, many of which are painful. Maybe poorer patients die sooner but more comfortably? Are they just given 'comfort care' and left alone? Are they well cared for or neglected? The book doesn't address this at all.

However, after reading the book, I made some changes in my medical directions concerning my end care, put my property in my and my heirs names, changed my bank account to POD (Pay on Death) to my only child and made plans to supervise my living arrangements as long as I am conscious and competent to do so. Also, spoke to my Complementary Care doctor about my wishes. However, I understand that what we wish and plan for today my be far different from what actually occurs.

Oh yes, when being treated as a terminal patient, put on make-up. Doctors seem to like that.

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From the United States

The Old and Sick Are Not Children

Reviewed in the United States on May 26, 2016

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497 people found this helpful

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"There is a time for everything..." (Ecclesiastes 3:1)

Reviewed in the United States on February 20, 2018

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Dr. Gawande writes that modern medicine can extend the limit of our mortality, but there is a finite boundary to that limit. This book is emotionally difficult because the reader and Dr. Gawande confront painful topics that one is loath to consider: aging, frailty and death. Yet, these are essential stages of life and there are essential decisions that one must make at each stage.

One can see the signs of aging as they appear on the outside: gray hair, age spots, and wrinkles. Dr. Gawande, a surgeon, also shares what he sees when he peers inside the body of an older patient. Each day some parts of the body die and are remade while others wear and change with constant use. What happens when the limitations of one's aging body require a change in one's lifestyle? There are now many choices and Dr. Gwande rails against settling for just safety and longevity, institutionalization and restriction. He relates the history of nursing homes and visits first-hand the many options for living a life of privacy and community, of vibrancy and purpose. He applauds those in the field of gerentology who have thought "outside the box" for the development of active communities for those who are aged and frail.

The reader experiences the morphing of Dr. Gawande from a mere practitioner to the son of a dying parent. How does a doctor broach the difficult end-of-life options with terminally ill patients and loved ones? The menu of medical options for treatment can be insufficient and it is essential that the practitioner also ask the patient what she or he wants most in the finite time remaining. Is it a mistake to prolong suffering or is it better to provide value in a shortened life? The author suggests that courage is required for both aging and sickness: the courage to confront the reality of mortality and the courage to act on the truth of that reality. Have the courage and the wisdom, dear reader, to explore these difficult topics presented in the pages of this transformative book.

155 people found this helpful

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Sithmaith

This book literally changed my life

Reviewed in the United States on October 26, 2017

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I can't say enough about how much I love this book. It literally changed my life and I recommend it to everyone.

This is the second time that I've read it. The first was during a particularly anxious time in my life. Someone very close to me was diagnosed with cancer, just a few days after Robin Williams committed suicide and just a few days before the anniversary of my sister Ginger's suicide. Not long after this, a long time colleague died of lung cancer. And all of this was while my beloved job was ending because our plant was shutting down permanently and my friends and colleagues were scattering to the four winds where I would likely never see them again. Needless to say, it was a rough time, and I began suffering from anxiety in a way I'd never experienced. I would lie awake at night, unable to sleep, worrying about death - mine, people close to me, my dogs. My doctor prescribed Prozac, but that really didn't help.

This book is what made all the difference. So much of anxiety is really about uncertainty and a loss of control, and death is something that most of us are unfamiliar with. Where once you lived with elderly relatives who aged, became infirm, and died, now the act of dying has been turned over to the medical establishment. Most people don't die at home, and elderly relatives don't live with us. They're independent as long as they can be, then they enter nursing homes or assisted living facilities. We don't want to talk about death, often because we superstitiously believe that will bring it to us.

So we grow old and die without being prepared for it. While most of us would say that we want to die peacefully at home, surrounded by family and friends, we don't know how to make that happen, and because we don't, that isn't usually how we go.

This book helps us work through the things that are important to us - what makes life worth living and how we can maintain that worthwhile life as long as possible. It demystifies aging and death, and helps us understand the choices that we will have to make, for ourselves and for others.

Dr. Gawande helps us understand how the medical establishment looks at death, and why they're not really prepared to help us to age and die in the way we would like. He admits his own mistakes and shows how what he's learned helped make his own father's transition what his father wanted it to be.

Even if you don't want to think of your own mortality, most of us are going to be involved in helping loved ones age and die. Read this book, and it will remove much of the uncertainty. It shows how we can have the end of our life be under our control as much as possible, and how to accept when that control is no longer possible.

138 people found this helpful

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Franklin the Mouse

Maintaining The Integrity Of One's Life

Reviewed in the United States on December 29, 2017

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The late Dr. Sherwin Nuland wrote a highly informative book entitled 'How We Die'. Dr. Gawande's book title could have been 'How We Are Allowed to Die'. It goes the next step and analyzes the medical establishment and how humans deal with their coming death. Well into the early twentieth century the Grim Reaper was a daily companion and a near fatalistic attitude was held in our culture about it. From babies to healthy adults were susceptible to a myriad of ways of quickly kicking the bucket. The latter part of the twentieth century, however, introduced medical and technological discoveries which helped prolong the inevitable. Ironically it also altered our culture's mindset about dying itself and we have become less willing go gently into the night. As the author so aptly states, “… (we are) a society that faces the final phases of life by trying not to think about it.” 'Being Mortal' does an outstanding job of guiding the reader through the complexities involved in our deteriorating bodies and end-of-life care.

Dr. Gawande has a clear and compassionate writing style. He is a humble physician who openly relays his ignorance in many aspects of medicine outside his field of expertise. The reader is taken along on the author's journey of discoveries. The book's core helps you understand the emotional challenges for the patient, their loved ones, and the ham-handed approach taken by hospitals who focus on prolonging death even if it overlooks the patient's wishes. These are not cut-and-dried issues. The author retells compelling episodes of people struggling with either their mortality or the loss of their autonomy. He even includes a story of the very personal loss of his dad. They are all excellent examples. Dr. Gawande covers such things as demographic shifts in aging, the history of dying in America prior to the late twentieth century, the creation of nursing homes, assisted-living facilities, how our motivations shift as we age, how we respond to pain, and assisted suicide.

'Being Mortal' is a superb book. It does not bog itself down in technical medical jargon but is written for the average person. It is not a self-help book but I imagine it will be therapeutic and helpful to most readers. The book also is not simply about the last days of a person's life but also facing and adapting to our body's inevitable decline. I can think of no book I've ever read that does a better job of presenting the issue. Read it for yourself and your loved ones. Even if you have already gone through the death of someone important in your life, the book may be some solace. We're all members of the dying club. No one is allowed to quit the merry death band and become immortal.

56 people found this helpful

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Elle Dee

I love this book so much i bought a copy for ...

Reviewed in the United States on March 16, 2018

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I love this book so much i bought a copy for my mother's primary care physician, neurologist, memory care manager and preacher. When someone you love is dying, how do you even begin to know how to think about it? This book has been a rock under my feet. However, it's biggest weakness is in it's lack of coverage of dementia patients. What do you do when the answers to "what is a good day in your current state?" changes in ways no one can predict and they cant articulate? What do you do when you ask them if they understand their condition and limitations and they have no clue they have dementia? These are my struggles with my parents (both have dementia). At the same time, there was still a lot of useful advise about dying. I highly recommend it.

56 people found this helpful

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The End Game scenario(s)…

Reviewed in the United States on May 21, 2018

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Thanks to my son, and his upcoming marriage, now only two weeks away, I have become reacquainted with members of the community I was once a part: the medical one. At one social gathering I was talking with a medical resident who worked in an Emergency Room. I asked him if he had read Abraham Verghese’s The Tennis Partner which is set in nearby El Paso and involves an E.R. Resident and drug addiction. He hadn’t and said he would put it at the top of his reading list. He returned the book recommendation favor by introducing me to another American physician with origins in the Indian subcontinent: Atul Gawande.

This work is of particular interest for a couple of reasons: for the better part of a decade, at the commencement of my work in the medical field, I was in the field of geriatrics. And now, the issues of geriatrics, and empathy for “creaky bones” are no longer exclusively the concern with others.
Gawande’s central thesis is that one of the most important questions of life – the way that it will end – is being handled quite poorly, with the “default option” being to prolong it, via medical technology. And this prolongation is against the wishes of the vast majority of the patients, as well as their relatives. He commences with a description of a dying patient in literature – Leo Tolstoy’s The Death of Ivan Ilyich (Bantam Classics) ). From there, like many a physician, he moves on to various case histories. Notably, a number of these are ones that he has known personally, such as Alice Hobson, the grandmother of his wife-to-be. Hobson, like so many others, has the strongest possible desire to live independently as long as possible: many succeed for impressive periods, but eventually, as Gawande explains about complex mechanical systems, things eventually just “fall apart,” and even our built-in systems of redundancies are insufficient. Help is needed.

The author provides case histories of the efforts to provide that help. It is difficult to believe that the first “assisted living” facilities were built only in the 1980’s. Gawande details the work of Karen Brown Wilson in building the first one in Oregon. Another pioneer was Dr. Bill Thomas, a somewhat eccentric Harvard-educated family health physician-farmer who wanted to bring some life, literally, into nursing homes, via pets, other animals, and young kids.

Again, and yet again, Gawande raises the issue of the “difficult conversations.” What does the patient actually want? What are the tradeoffs? And when is it time to “let go”? A blunt-spoken nurse asks not how you are feeling, but what is your funeral home preference. The following passage particularly resonated: “We’ve created a multi-trillion-dollar edifice for dispensing the medical equivalent of lottery tickets – and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win. Hope is not a plan, but hope is our plan.”

The last chapter is entitled “courage.” Gawande demonstrated that with his frank discussion of the death of his father, who was also a physician, having emigrated from India to Athens, Ohio. He had an unusual and most difficult end-case scenario – a tumor within the spinal column. Even being within the medical field, it is difficult to obtain the care one desires. One physician suggested with treatment he could “…be back on a tennis court this summer.” As Gawande says: “…I was spitting mad that she would dangle that in front of my father.” Gawande would eventually take part of his father’s ashes to the very polluted Ganges River, take the ritualistic three sips of water from the river, and contract Giardia for his efforts.

Another form of pollution is largely missing from Gawande’s account: “filthy lucre.” I believe that Gawande overlooks the large financial incentives within the American medical establishment for unnecessarily prolonging life… he mentions the “lottery ticket,” as indicated above, but it really does deserve an entire chapter. And from my father’s medical treatment and death, I realized how that establishment carefully calculated insurance availability for “rehabilitation” at 100 days, and even though he was effectively brain-dead, dangled that same “tennis court” scenario to the family. Sure enough, he had 97 days of “potential.”

Overall, an impressive work, and I will be reading other works of this humane, thoughtful and knowledgeable physician. 5-stars.

46 people found this helpful

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Patsy Brunner

A must-read for everyone.

Reviewed in the United States on September 12, 2017

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Now that I've finished this book, I am even more convinced that it should be required reading for all adults. Don't wait until you're older, or caring for someone, or need care yourself. Read it now. Understand what's coming, what the real issues are, what kind of priorities we should be setting, and, most of all, what is POSSIBLE. Face the future - for yourself or loved ones - without illusion or fear.

I'm not going to give a blow-by-blow rundown, but rather I'll say this: Dr. Atul Gawande's book gives the reader history, medical information, hope, moving true tales, courage, and wisdom which we all need as we walk through our lives.

I can honestly say I've never been afraid of dying - it's an inevitability. But if I had been this would have eased those fears. For me, it adds to my body of knowledge and understanding.

38 people found this helpful

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This book could be a game changer

Reviewed in the United States on September 23, 2014

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This book could be a game changer, if enough people read it and take it to heart. Atul Gawande addresses end-of-life care, and how we're getting it wrong, both within the medical establishment and in our families.

Dr. Gawande's book focuses both on medical procedures and living conditions in later life. He addresses the reality that as people near the end of life, decisions about their living situation are primarily aimed at ensuring safety at the expense of retaining autonomy, especially when adult children are making the decisions. "We want autonomy for ourselves and safety for those we love," a friend tells the author. We mistakenly treat elders as children, Dr. Gawande says, when we deny them the right to make choices, even bad choices. People of any age want the right to lock their doors, set the temperature they want, dress how they like, eat what they want, admit visitors only when they're in the mood. Yet, nursing homes (and even assisted living communities) are geared toward making these decisions for people in order to keep them safe, gain government funds, and ensure a routine for the facility.

In addition, Dr. Gawande shows how end-of-life physical conditions are most often treated as medical crises needing to be "fixed," instead of managed for quality of life when treatment has become futile. Life is more than just a stretch of years; it must have meaning and purpose to be worth living, he says. This is a familiar concept (in fact, I read parts of this book in The New Yorker ), but he builds a strong case for reform through case studies, stories from his own life, and examples of how individuals are either becoming victims of, or bucking, the system. He addresses assisted suicide only briefly, but he mentions it in relation to end-of-life care. "Assisted living is far harder than assisted death, but its possibilities are far greater as well," he writes.

The good news is that some people are doing what they can to improve the well-being of elders nearing the end of their lives. He demonstrates the beauty of hospice care in the home. He tells a great story of a doctor who convinced a nursing home to bring in two dogs, four cats and one hundred birds! It was a risky proposal, but the rewards were phenomenal. It made the place, and the people, come alive. I am aware, though, that these movements rely on individuals, and only if enough people have a vision for change will it come about. For that reason, I hope this book makes a big splash!

1,231 people found this helpful

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Bridgman

Excellent book on gloomy topic

Reviewed in the United States on November 27, 2017

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If you’re friends with a doctor or a police officer you are probably either a doctor or a police officer yourself.
Both occupations give their practitioners intimate views to dramatic times in the lives of others. This often leads them to having a clubby, supercilious view of what they’d call “civilians,” or “ordinary people” that makes much of what they’ve written come off as condescending, even smug.
Atul Gawande avoids that in Being Mortal—Medicine and What Matters in the End. Gawande, a Harvard Medical School professor and Brigham and Women’s Hospital surgeon who writes best selling books and articles for The New Yorker, shares his shortcomings and what he learns along his way through the mess of the American healthcare system’s handling of its citizens last days.
Gawande writes well and researches his subject objectively. Being Mortal has an introduction, eight chapters, and an epilogue. To me, the beginning of the epilogue sounds like it would have made a good introduction:

Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and the cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be.

This is the kind of book you keep. Not that you’ll want to go back and reread the case histories Gawande uses to illustrate his ideas: none of them has a happy ending. But the book as a whole is tantamount to having the hard conversations (the title of the seventh chapter) that nearly everyone will have at some point near the end of his or her life and probably the life of someone he or she is close to. Gawande has seen enough and thought enough that he has gained genuine wisdom that may not be greater than that of the reader, but has been put into words well, like this from the last chapter:

In the end, people don’t view their life as merely the average of all of its moments—which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people’s minute-by-minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life may be empty. A seemingly difficult life may be be devoted to a great cause. We have purposes larger than ourselves.

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Not an Easy Read, But an Essential One

Reviewed in the United States on October 24, 2017

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"Being Mortal" is not an easy read but an essential one to pave the way for a less terrorizing final exit. With a growing population of elderly baby boomers, we need more people and industry focusing on geriatrics and elder care, but this area is sadly under-subscribed because few professionals want to work with cranky old people. The medical industry has concentrated primarily on keeping a person alive as long as possible but has been ill-prepared to deal with patient realities and druthers in the final stage of life. Atul Gawande sheds light on the options available during the final stages of life. The book uses numerous patient experiences, including that of Gawande's own father, to explore the successes and failures of these options. Some of these options are grim and grimmer, but others often prolong a patient’s quality and length of life. I found that I had to put the book down frequently because it deals with very sad scenarios. I had to catch my breath as I read about some of my worst nightmares. But I am thankful for the information so that I can prepare myself to“rage, rage against the dying of the light.”

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