Shaping the last chapters of life

A review of Being Mortal: Medicine and What Matters in the End by Atul Gawande

GawandeNear the end of this 260-page book, the author states a fact of life that most people already know. When we face the endings of life, “no one ever really has control. Physics and biology and accident ultimately have their way in our lives. But the point is that we are not helpless either.” The guiding principle is that within these limits we “have room to act to shape our stories, though as time goes on it is within narrower and narrower confines” (243). At this point, author Atul Gawande summarizes the themes he has presented throughout this persuasive and interesting book.

First, our “most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer. This misunderstanding is widely distributed through American society and is sharply focused in the medicalization and institutionalization of elder care. Throughout the book Gawande illustrates this theme with stories of people whose last chapters were made increasingly difficult because of treatments that well meaning people, including family, friends, and medical providers, had thought to be right.

Second, the “chance to shape one’s story is essential to sustaining meaning in life.” Here, too, Gawande supports his thesis with life stories—of people he has met in his medical practice and members of his family, both in India and the United States. In the epilogue he expresses appreciation to more than 200 people who had shared their stories with him. These life accounts demonstrate that people cope with their mortality best when they a determining voice in decisions about the care they are to receive.

Gawande’s third theme is that we now “have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s life.” He writes in an encouraging vein because many people already are at work in this reformation of the ways that our society relates to people who are living their last chapters. In part, Gawande’s purpose is to explain and affirm changes already taking place. Another purpose is to encourage people who are now in their last chapters of life to avail themselves of these increasingly available opportunities. Furthermore, he intends to instruct people like himself—professional care givers and immediate family members and friends—about their supporting roles in helping people they know age and move toward death in the best ways possible.

Being Mortal has a strong autobiographical cast. Gawande is a surgeon at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School. His late father also was a surgeon and his mother is a physician. In the earlier portions of the book, he tells about his own efforts to understand people as they faced their mortality and the new modes of supporting them that are developing across the nation. He describes the presuppositions he brought into his medical practice, especially the assumption that his primary responsibilities as a surgeon were to prolong life and keep people safe. With similar candor he describes how difficult it has been for him to develop a new set of priorities and better ways of communicating with patients, their families, and medical practitioners like himself who were schooled in the prevailing medical model. Continue reading Shaping the Last Chapter

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One Response to Shaping the last chapters of life

  1. Dave says:

    Having spent much of last week thinking of Robin Williams and suicide, this is a wonderful followup for me to think on. Be well!

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