Tea & A Good Book Brewing- Installment 36, Being Mortal
As I was thinking what to write in today's book review, I wished that I could simply say, "Everyone must read Being Mortal!" and be done with it.
It really is that good.
And while the book is not necessarily one you read for pleasure or in order to relax- which is probably why it took me all month to get through it- the content is deeply thought provoking and thereby well worth wading through to the very end.
I often have trouble putting together a succinct review on the books that I read, and this book is no exception. In fact, it is probably one of the most difficult to date since I fear I will not do justice to what the book has to say, as well as the conclusions that the author comes to.
One of the best ways to tell you what the book is about is to give you a quote by the author in the introduction:
"This is a book about the modern experience of mortality- about what it's like to be creatures who age and die, how medicine has changed the experience and how it hasn't, where our ideas about how to deal with the finitude have got the reality wrong. As I pass a decade in surgical practice and become middle aged myself, I find that neither I nor my patients find our current state tolerable. But I have also found it unclear what the answers should be, or even whether any adequate ones are possible. I have the writer's and scientist's faith, however, that by pulling back the veil and peering in close, a person can make sense of what is most confusing or strange or disturbing."
Atul Gawande then goes on to explore this somewhat treacherous territory called mortality, along with the question: what really does matter in the end?
The first several chapter look closely at aging, and how our expectations and culture define that process, as well as what people really want during that period of their lives.
Once again, I quote:
"The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had no view at all. Medicine's focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet- and this is the painful paradox- we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns. It's been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than their understanding of human need.
The experiment has failed. If safety and protection were all we sought in life, perhaps we could conclude differently. But because we seek a life of worth and purpose, and yet are routinely denied the conditions that might make it possible, there is no other way to see what modern society has done."
The author explores, both through research, statistics and personal stories (which are very interesting) what it is that elderly people really need and want in their final years, particularly once their independence is gone, and his conclusion is that they want a life that still has worth and purpose. Sadly, it is often the very homes & systems that are put in place to care for the elderly that strip them of those very things, because concerns for safety and health become paramount over quality of life.
"The terror and sickness of old age is not merely the terror of the losses one is forced to endure but also the terror of the isolation. As people become aware of the finitude of their life, they do not ask for much. They do not seek more riches. They do not seek more power. They ask only to be permitted, insofar as possible, to keep shaping the story of their life in the world- to make choices and sustain connections to others according to their own priorities."
In the final three chapters, called Letting Go, Hard Conversations and Courage, Atul explores end-of-life issues, particularly as they relate to those dying from ill health, rather than old age.
In his research, Atul realized that as people's capabilities waned, whether through old age or ill health, making their lives better often requires curbing our purely medical imperatives- resisting the urge to fiddle and fix and control.
However, this comes with a difficult question: When should we try to fix and when should we not?
"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 cost 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 achieve what's most important to them at the end of their lives."
Keep in mind that this book is written by a doctor, and that the writing of the book seems to be his own way of learning how to relate to, and better assist, the patients under his care who are dying. To make the story more personal, the author tells of his own father (a Urologist) who is discovered to have a tumor on his spinal cord and which eventually claims job, his mobility, his hobbies...and his life.
Drawing from his experiences both with his patients and his own father, Atul talks about the need of having the hard conversations in order to discover what really is important to the one who is at the end of life. These "breakpoint discussions" are a series of conversations to sort out when someone needs to switch from fighting for time to fighting for the other things that people value- being with family or traveling or enjoying chocolate ice cream.
The content of the books is sad. Really, who wants to think about mortality and the kinds of things that should be given priority at the end of life?
Atul's perspective is not necessarily Christian- although peace with God is mentioned as a priority for many at the end of life- but reading between the lines gave me glimpses of saving graces.
Death will always be the last enemy, and illness, disease, and old age will always be part of the curse, but the Believer has real reason to rejoice at the end of it all.
There's a Savior on the other side.
When the perishable puts on the imperishable, and the mortal puts on immortality, then shall come to pass the saying that is written: "Death is swallowed up in victory."
1 Corinthians 15:54 (ESV)
It really is that good.
And while the book is not necessarily one you read for pleasure or in order to relax- which is probably why it took me all month to get through it- the content is deeply thought provoking and thereby well worth wading through to the very end.
I often have trouble putting together a succinct review on the books that I read, and this book is no exception. In fact, it is probably one of the most difficult to date since I fear I will not do justice to what the book has to say, as well as the conclusions that the author comes to.
One of the best ways to tell you what the book is about is to give you a quote by the author in the introduction:
"This is a book about the modern experience of mortality- about what it's like to be creatures who age and die, how medicine has changed the experience and how it hasn't, where our ideas about how to deal with the finitude have got the reality wrong. As I pass a decade in surgical practice and become middle aged myself, I find that neither I nor my patients find our current state tolerable. But I have also found it unclear what the answers should be, or even whether any adequate ones are possible. I have the writer's and scientist's faith, however, that by pulling back the veil and peering in close, a person can make sense of what is most confusing or strange or disturbing."
Atul Gawande then goes on to explore this somewhat treacherous territory called mortality, along with the question: what really does matter in the end?
The first several chapter look closely at aging, and how our expectations and culture define that process, as well as what people really want during that period of their lives.
Once again, I quote:
"The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had no view at all. Medicine's focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet- and this is the painful paradox- we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns. It's been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than their understanding of human need.
The experiment has failed. If safety and protection were all we sought in life, perhaps we could conclude differently. But because we seek a life of worth and purpose, and yet are routinely denied the conditions that might make it possible, there is no other way to see what modern society has done."
The author explores, both through research, statistics and personal stories (which are very interesting) what it is that elderly people really need and want in their final years, particularly once their independence is gone, and his conclusion is that they want a life that still has worth and purpose. Sadly, it is often the very homes & systems that are put in place to care for the elderly that strip them of those very things, because concerns for safety and health become paramount over quality of life.
"The terror and sickness of old age is not merely the terror of the losses one is forced to endure but also the terror of the isolation. As people become aware of the finitude of their life, they do not ask for much. They do not seek more riches. They do not seek more power. They ask only to be permitted, insofar as possible, to keep shaping the story of their life in the world- to make choices and sustain connections to others according to their own priorities."
In the final three chapters, called Letting Go, Hard Conversations and Courage, Atul explores end-of-life issues, particularly as they relate to those dying from ill health, rather than old age.
In his research, Atul realized that as people's capabilities waned, whether through old age or ill health, making their lives better often requires curbing our purely medical imperatives- resisting the urge to fiddle and fix and control.
However, this comes with a difficult question: When should we try to fix and when should we not?
"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 cost 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 achieve what's most important to them at the end of their lives."
Keep in mind that this book is written by a doctor, and that the writing of the book seems to be his own way of learning how to relate to, and better assist, the patients under his care who are dying. To make the story more personal, the author tells of his own father (a Urologist) who is discovered to have a tumor on his spinal cord and which eventually claims job, his mobility, his hobbies...and his life.
Drawing from his experiences both with his patients and his own father, Atul talks about the need of having the hard conversations in order to discover what really is important to the one who is at the end of life. These "breakpoint discussions" are a series of conversations to sort out when someone needs to switch from fighting for time to fighting for the other things that people value- being with family or traveling or enjoying chocolate ice cream.
The content of the books is sad. Really, who wants to think about mortality and the kinds of things that should be given priority at the end of life?
Atul's perspective is not necessarily Christian- although peace with God is mentioned as a priority for many at the end of life- but reading between the lines gave me glimpses of saving graces.
Death will always be the last enemy, and illness, disease, and old age will always be part of the curse, but the Believer has real reason to rejoice at the end of it all.
There's a Savior on the other side.
When the perishable puts on the imperishable, and the mortal puts on immortality, then shall come to pass the saying that is written: "Death is swallowed up in victory."
1 Corinthians 15:54 (ESV)
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