Courage & Humanity

Being Mortal: Medicine and What Matters in the End by Atul Gawande

My rating: 5 of 5 stars


'Being Mortal' by Atul Gawande is not for the lily-livered. As its subtitle indicates - "Illness, Medicine, and What Matters in the End"- this is a book that stares stark reality in the face, via case-history after case-history of terminal diagnoses (mostly of cancer) and descriptions of death. At times I had to put it aside and take a breather. There is just so much of one's darkest imaginings that one can take: the sore throat which turns out to be a fatal tumour, the back ache which turns out to be a fatal tumour, the headache which turns out to be a fatal tumour... For those of us still dodging such bullets, it made for gruelling reading.

However! If you are still with me, which I hope you are, let me quickly add that Atul Gawande may be a man of science, but he writes as a man of the deepest compassion and understanding, using very moving personal experiences as well as professional anecdotes to make his points. Yes, the subject of 'Being Mortal' is, ultimately DEATH, but that is the Elephant In The Room for all of us. We are all dodging bullets one way or another! We are all going to die! So we should not be afraid to look that fact in the face, or at the very least, to discuss looking it in the face. I applaud Atul Gawande with all my heart for doing so.

Crucial to Gawande's thesis is the recognition of the failure of most doctors to know how to handle terminal illnesses in their patients. He realised this himself long after qualifying, a moment of epiphany, when he saw that, as a medic, he had merely been taught how to 'fix' things. Whenever fixing became impossible he was floundering, thereby ensuring that patients floundered too. For it is the 'fixing' mentality the lies behind the prescription of expensive, intrusive and often debilitating treatments which might buy weeks or months of possible extra existence, but at the cost of the potential quality of life a patient might yet enjoy. Gawande cogently points out the madness of this, arguing that instead, with the right conversations between medics, patients, carers and loved ones, the final stretch of a life can be about fulfilment rather than fear. All it takes is the courage for the right questions to be asked,and the answers listened to. Like the guy who said he would prefer to be able to eat ice cream and watch baseball games rather than risk total paralysis through a operation on his spine. He died, eventually, but on his own terms, with minimum discomfort and able to communicate with his family until the end.

Atul Gawande is certainly courageous, to write a book that goes to the heart of this difficult debate. He also gives of himself, weaving a moving account of the sudden illness and decline of his own father through the narrative. As a personal story, it moved me to tears. It also underpinned the wider point that Gawande is making: We each deserve to be able to savour every last drop of our lives. If we cannot do our best to make that happen, if we cannot, in other words, deal humanely with our own mortality, then what right have we to call ourselves civilised?



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