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Being Mortal: Medicine and What Matters in the End
Being Mortal: Medicine and What Matters in the End
Being Mortal: Medicine and What Matters in the End
Audiobook9 hours

Being Mortal: Medicine and What Matters in the End

Written by Atul Gawande

Narrated by Robert Petkoff

Rating: 4 out of 5 stars

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About this audiobook

In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

A Macmillan Audio production.

LanguageEnglish
Release dateOct 7, 2014
ISBN9781427244246
Being Mortal: Medicine and What Matters in the End
Author

Atul Gawande

Atul Gawande is the author of three previous bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist Manifesto. His current book, Being Mortal, was a New York Times Bestseller. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for the New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In 2014, he delivered the BBC Reith Lectures. In his work in public health, he is director of Ariadne Labs, a joint centre for health system innovation, and chairman of Lifebox, a nonprofit organisation making surgery safer globally. He and his wife have three children and live in Newton, Massachusetts.

Reviews for Being Mortal

Rating: 4.201171875 out of 5 stars
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  • Rating: 5 out of 5 stars
    5/5
    this is a must-read!
  • Rating: 4 out of 5 stars
    4/5
    A must-read for anyone with aging parents.
  • Rating: 4 out of 5 stars
    4/5
    The author, a general surgeon, has spent his professional career trying to do what he was taught: fix his patients physically. Quantity of alternatives, not necessarily quality of life. It was assumed that longevity was worth any inconvenience and pain. A few years ago he began researching end-of-life care options with the goal of improving the lives of his elderly and end-stage patients. He consulted patients, geriatricians, pioneers in independent care programs, and hospice organizations, and provides the reader with a look at traditional nursing homes (and their history), home care and institutional alternatives, and trade-offs made by patients and families. His own father's illness and death provided him with a chance to put to use some of the techniques he'd learned. The nursing home chapters describe typical (and nightmarish) conditions, and it was all I could do to continue. But once the book turned to the alternatives being developed, I found myself less traumatized thinking of my own future. While traditional medical care might stress the goal of prolonging lives, this often leads to situations that are the opposite of what patients really want, which is, typically: avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. (These issues become priorities not only to old people but to younger people who find themselves facing illness and end-stage disease.) In nursing homes, where the emphasis is on keeping patients physically safe, patients can feel imprisoned, without privacy or the right to make decisions about how to spend their time and with whom.Doctors are traditionally trained to offer fixes, including those which are more and more experimental or unlikely to help. They are not taught to suggest there might be more meaningful alternatives, and sometimes the end of treatment. The author learned to ask very ill patients several questions, which even he, with all his new knowledge and desire to improve matters, found extremely difficult to do:At this moment in your life:1. What do you understand your prognosis to be?2. What are your concerns about what lies ahead?3. What kinds of trade-offs are you willing to make? How much are you willing to go through to have a shot at being alive, and what level of being alive is tolerable to you?4. How do you want to send your time if your health worsens?5. Who do you want to make decisions if you can't?I was profoundly moved by the range of these questions and the responses they elicited. Clearly, patients aren't always thinking about the same things as other patients, or their families, or their health care workers. One striking result was that that families and doctors, finding themselves at a crisis moment in the patient's life, didn't have to make the hard decisions - the patients had already said what they wanted. An excellent overview of possibilities for anyone concerned with these issues.
  • Rating: 4 out of 5 stars
    4/5
    You have to read it
  • Rating: 5 out of 5 stars
    5/5
    This book made me cry several times; contemplating one's own aging and mortality, and having Gawande narrate the end-of-life stories of his patients and his own father, was sobering and thought provoking
  • Rating: 5 out of 5 stars
    5/5
    “A colleague once told her, Wilson said, ‘We want autonomy for ourselves and safety for those we love.’ That remains the main problem and paradox for the frail.”

    The above quote sums up beautifully much of what Dr. Gawande discusses in this really lovely, interesting and motivating book. Being Mortal focuses on how modern medicine has failed us in that it can keep people alive much longer than it used to, but often at a very serious cost. His focus is primarily on the elderly, but he also includes the seriously, terminally ill in this exploration.

    Think about the above quote. We all want to do what we want – to have the freedom to decide when we will get up in the morning, what we will eat, and who we will spend time with. But, when it comes to our loved ones, it seems that so often what we most want is for them to be safe. It is that concern that has led us to do things like put people into nursing homes to keep them safe from falls, even though they are much more miserable. As long as they are safe, that’s all that matters. But Dr. Gawande makes the very compelling argument that the safety isn’t the primary concern, or shouldn’t be. Allowing people to live meaningful lives, whatever the person’s own definition, should be our concern as people age or experience the end stages of a terminal illness.

    The book does a great job of illustrating how doctors really shy away from having the frank conversations with their seriously ill patients. They provide information, but that information is often based on what to do to lengthen life, not improve the quality of it. Taking a page from the palliative care / hospice movement, Dr. Gawande advocates for asking the hard questions, like what do the patients fear most, what is the quality of life they’d be willing to tolerate, and similar questions, to really get at the heart of their concern.

    Dr. Gawande also looks at how, especially with the elderly, we focus too much on keeping them safe as opposed to happy. He provides the back story on the nation’s first true assisted living facility, where residents were allowed to do things like lock their doors. Yes, they might fall, but the staff was dedicated to providing whatever support services were necessary to allow these residents to keep as much independence as possible. It is amazing when you really think about how much we focus on things like fall prevention (which is important, obviously), but not on really figuring out ways to prevent the falls WHILE allowing people access to the things in their lives that matter, like deciding when to get out of bed in the morning.

    I strongly recommend this book, especially for those who have parents who are elderly, or for those who care about the quality of life of seriously ill people. It asks us to reframe our thinking, and really consider what it is that we value, and how we would want others to take that into consideration as we got older or sicker.

    And with that, I complete my second Cannonball Read. I’ve put together a wrap-up post over on my own blog: