We’re all going to die, apparently. I’ve known enough of death to assiduously avoid thinking about it until it’s too close to ignore. The other week I visited a friend in hospice. He spent his last days holding court and watching herons stalk frogs in the wetlands beyond the windows. His room seemed more like a hotel than a hospital, with floor-to-ceiling glass and plush lounge chairs. A few weeks earlier he’d had a cough checked, now he was dying—or at least, now he knew he was. There would be no heroic efforts to prolong his life, just medication to enhance its quality. He talked about what he valued. He felt at peace. The next week, he was too tired for visits, so we talked by phone. Then he slipped into death. It was timely to pick up “Being Mortal” by physician writer Atul Gawande a few days later.
We all know the quip about the certainty of death or taxes, but still they creep up and catch us unawares. We don’t consider our life’s end thoroughly enough, asserts Gawande. He writes to “lift the veil” on the whole ghastly institutionalized business of illness, aging and dying, in order to refocus on what he believes to be most important—sustaining meaning in life. He wants us to have an urgent conversation about issues of autonomy and maintaining the integrity of one’s life, so we don’t lose ourselves at the end.
Gawande’s great skill is in synthesizing complex medical and social data with literature and personal narrative. He weaves the moving story of his father’s demise into discussions on independence, loss of privacy and prolonging suffering through inappropriate medical interventions. Using Tolstoy’s classic “The Death of Ivan Ilyich,” he broaches society’s unwillingness to talk frankly about dying, and the “terror of isolation” feared by many older people.
The hospice movement, in situ and in homes, has already enhanced our experiences with terminal illness. We need to do better with hospital experiences and figure out how to live well as we get old. My neighbor, who works in home health care, reports seeing his patients reading “Being Mortal,” so we might be in for a sea change. Gawande posits the idea that a life worth living can be created for all stages of life. The job of medicine is not merely to ensure health and survival, but to enable wellbeing. He asks us to have the courage to confront our mortality, to be more honest about our limits, and work actively toward more humane approaches to our inevitable ends. Gawande makes reading about death easy. (Toni Nealie)
“Being Mortal: Medicine and What Matters in the End” By Atul Gawande Metropolitan Books, 304 pages, $26
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