Being Mortal by Atul Gawande

  • How much I’d Recommend: 9/10
  • Date finished: 10/4/21
  • Being Mortal, recommend borrowing from your local library or buy a used copy

🚀 Three sentences to summarize the book:

  1. This book is not just for people who are older. It’s for everyone as everyone is mortal.
  2. It addresses very hard but necessary questions about what we value the most at the end of our life.
  3. Being mortal is about the struggle to cope with the constraints of our biology.

☘️ How did this book change the way I think/work/learn:

  • This book makes me think about what I define my life purpose is, and life purpose can change so quickly, and how even if one’s mobility, single source of life purpose became impossible because of old age, a new purpose can be found in caring for others, contributing to the community, etc. One can survive merely on medical interventions, but living requires a lot more. It requires a purpose to give us the will to continue.
  • It also makes me realize that a lot of the times doctors don’t have all the answers, and diseases are part of human life & aging. We are all headed in the same direction, but to make the journey not a painful one, it has to be consciously thought-out, and deliberately discussed choice.

📒 Favorite Quotes:

  • Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things.
  • We think, nostalgically, that we want the kind of old age my grandfather had (where his son & daughter-in-law took care of him until he died at age 110). But the reason we do not have it is that, in the end, we do not actually want it. The historical pattern is clear: as soon as people got the resources and opportunity to abandon that way of life, they were gone.
  • Historians find that the elderly of the industrial era did not suffer economically and were not unhappy to be left on their own. Given the opportunity, both parents and children saw separation as a form of freedom.
  • We cling to the notion of retirement at 65—a reasonable notion when those over 65 were a tiny % of the population but increasingly untenable as they approach 20%. People are putting aside less in savings for old age now than they have at any time since the Great Depression. More than half of the very old own live without a spouse and we have fewer children than ever before, yet we give virtually no thought to how we will live out our later years alone.
  • The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don’t, morality is only a horror.
  • As our time winds down, we all seek comfort in simple pleasures—companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces. We become less interested in the rewards of achieving and accumulating, and more interested in the rewards of simple living.
  • Yet while we may feel less ambitious, we also become concerned for our legacy. And we have a deep need to identify purposes outside ourselves that make living feel meaningful and worthwhile.
  • Whatever the limits and travails we face, we want to retain the autonomy—the freedom—to be the authors of our lives. The value of autonomy…lies in the scheme of responsibility it creates: autonomy makes each of us responsible for shaping his own life according to some coherent and distinctive sense of character, conviction, and interest.
  • This is why the betrayals of body and mind that threaten to erase our character and memory remain among our most awful tortures.
  • People with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include 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. Our system of technological medical care has utterly failed to meet these needs, and the most of this failure is measured in far more than dollars. The question therefore is not how we can afford this system’s expense. it is how we can build a health care system that will actually help people achieve what’s most important to them at the end of their lives.
  • On Hospice: “99% understand they’re dying, but 100% hope they’re not,” she told me. “They still want to beat their disease.” “A nurse has five seconds to make a patient like you and trust you. It’s in the whole way you present yourself. I do not come in saying ‘I’m so sorry.’ Instead, it’s: ‘I’m the hospice nurse, and here’s what I have to offer you to make your life better. And I know we don’t have a lot of time to waste.”
  • Hospice has tried to offer a new ideal for how we die. Although not everyone has embraced its rituals, those who have are helping to negotiate an ars moriendi for our age. But doing so represents a struggle—not only against suffering but also against the seemingly unstoppable momentum of medical treatment.
  • Two-thirds of the terminal cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did have discussions were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive care unit. Most of them enrolled in hospice. They suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In addition, six months after these patients died, their family members were markedly less likely to experience persistent major depression. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.
  • A landmark 2010 study from the Massachusetts general hospital had even more startling findings… the result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussion were an experimental drug, the FDA would approve it.
  • Four crucial questions at end of life in la crosse wisconsin:

  1. Do you want to be resuscitated if your heart stopped?
  2. Do you want aggressive treatments such as intubation and mechanical ventilation?
  3. Do you want antibiotics?
  4. Do you want tube or intravenous feeding if you can’t eat on your own?

Crucial quesitons to discuss with your doctor:

What do you understand your prognosis to be? What are your concerns about what lies ahead? What kind of trade-offs are you willing to make? How do you want to spend your time if your health worsens? Who do you want to make decisions if you can’t?

How much you are willing to go through to have a shot at being alive and what level of being alive is tolerable to you?

  • I’m sorry things turned out this way ⇒ I wish things were different.
  • What do you want when you are dying ⇒ if time becomes short, what is most important to you?
  • The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You want Robert e Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.
  • People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and escape a warehoused oblivion that few really want.
  • We want information and control, but we also want guidance. The Emanuels described a third type of doctor-patient relationship, which they called “interpretive.” Here the doctors role is to help patients determine what they want. Interpretive doctors ask “what is most important to you? What are your worries?” Then, when they know your answers, they tell you about the red pill and the blue pill and which one would most help you achieve your priorities.
  • if to be human is to be limited, then the role of caring professions and institutions—from surgeons to nursing homes—ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.

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