Anyone who knows me is aware that I enjoy reading a great deal and usually find a recommendation from a friend a choice I will pick up. And so it was that someone recently recommended Atul Gawande’s 2014 best-selling book, Being Mortal, as a book everyone ought to read. As I look around my house these days, I need to decide on which books I buy and which others I might borrow from a digital library or listen to as an audiobook. This time I chose the audiobook since it could be a companion on a walk, but I now wonder if I will also buy the book as a reference.
Since it is not a new book, some (perhaps many) of you may already be acquainted with this title and its surgeon author, but it was new to me. It didn’t take me long to be caught up with the excellent audiobook narrator and the contents that brought together research as well as fascinating stories and interviews as this physician brings front and center the subject of our mortality. This topic is not one most of us jump into eagerly because even though we know we are mortal and life as we know it on this earth will end, we step back from talking (or learning) about what happens as we approach the end of what we know. Perhaps that is because the unknown combined with what we may have experienced leaves us uneasy and anxious over the impending loss of control.
The author, Dr. Atul Gawande, brings us front and center into the subject including what he as a physician was not trained to talk about as well as what medicine offers us now in the modern era. He honestly addresses the part medical personnel play in our dilemma about this subject due to the lack of information they give us as we age and become more frail and start that decline we dread. He makes clear that medicine at its best is there to address and fix a problem but aging and becoming more frail is not in itself a fixable problem and when it happens it is not usually one thing that goes wrong but a series of things that happen.
Dr. Gawande’s own history as the son of two physicians and grandson of a grandfather in India who lived until near 110 sets the stage for him to discover what he did not learn through his medical training. And he begins by outlining how medicine has changed over time and resulted in a very different system than those in western societies experienced in our grandparents and great-grandparents’ lifetimes. Back then, old age tended to be uncommon. As an example, in the United States in 1790, less than 2% of the population lived to the age of 65. The discoveries of medical science increased longevity and that was great news, but with it came other challenges like the shift in thinking between young and old and who would have control of places, positions, and ultimately their independence.
Along with that, choices about retirement age, where to live, what to do, and more abound as never before. Some, like the development of nursing homes, came from the medical community. Others came as counters to that choice including assisted living facilities, senior communities, home care, and a growing array of options to allow the seniors among us to retain as much independence and connection to the life they love as possible while providing them with safety and what medical care may be needed. These options grew also because Dr. Gawande notes “age is not a fixable problem” and doctors “have no answers.” Their answers are for specific problems, diseases, and diagnoses while aging is a complex set of systems that begin to wear out despite all we may do to prevent that. At some point the redundant systems our Creator put into our bodies result in too many failures that will lead to a problem that is not so fixable.
Two lenses are used to look at aging: the biological course and the cultural course on how we view aging. How those in the Roman Empire looked at this when the average life span was 28 is radically different no matter what lens is used for the average life span now that nudges us into the eighth decade of life for many (and beyond that for some).
Dr. Gawande takes the reader (or listener) through key topics in eight chapters: The Independent Self, Things Fall Apart, Dependence, Assistance, A Better Life, Letting Go, Hard Conversations, and Courage. In the process, you have a chance to look at the topics we don’t talk about and gain good information about how to go about aging as well as possible with less fear through more solid information and innovative ideas.
Even though the audiobook was to be a companion on my walks, I listened to some parts again as I wanted to take notes on things Dr. Gawande said and explained so well as he shared how what he has learned has changed his practice and life.
One of the things that stood out to me was when he described what he says a physician’s job is in supporting life and he puts it into two key sentences:
- To provide as much freedom from the ravages of disease as possible
- To retain enough function for active engagement in the world
Repeatedly, he makes the case for helping the aging maintain purpose and connection with living and the things they value most as keys to a better quality and quantity of life. He uses many examples that show treating the aging frail among us as children is not how to make the decline easier or better.
“The battle of being mortal is to retain the integrity of one’s life so who you are does not get disconnected from who you were or who you want to be.”Dr. Gutal Gwande
I heartily recommend this book if you are older or if you are looking at helping someone you love who is older. Expect to be validated and encouraged instead of anxious and discouraged. After all, in this life, we must all face being mortal.