Having greatly enjoyed ‘Do No Harm: Stories of Life, Death and Brain Surgery’ by Henry Marsh late last year, I wanted to read ‘Being Mortal: Illness, Medicine, and What Matters in the End’ by Atul Gawande, a book which formed the basis of the Reith lectures entitled ‘The Future of Medicine’ on BBC Radio 4 last year. Gawande is a writer and practicing surgeon based in Massachusetts who has published three other books about medicine. In ‘Being Mortal’, he tackles the wider issue of mortality addressing the process of aging, dying and death, without focusing on a specific area of healthcare or even his own career.
The book is split roughly into two halves, the first of which focuses on caring for an ageing population. Gawande surveys the experiences of assisted living, nursing homes and hospice care, of which most of the examples here are relevant to the healthcare system in the United States. The second half of the book is about palliative care and how patients cope with a diagnosis of terminal illness. Gawande weaves together stories of patients, colleagues and his own family including his grandparents in India and his father’s death from a tumour in his spine. It is Gawande’s exceptional storytelling ability which makes the book so readable despite the difficult subject matter.
Significant medical advances in recent decades have enabled doctors to greatly prolong life. Yet, as Gawande notes in the introduction, while doctors are taught to save lives, most are not trained to talk to patients about their options when faced with terminal illness. Moreover, most efforts to keep patients alive for longer often prove to be counterproductive. Gawande leaves aside potentially controversial religious debates surrounding topics such as euthanasia and focuses more about what actually matters to patients when they reach the end of their life. He addresses the issues clearly and thoughtfully whilst making a convincing case in favour of prioritising quality of life over quantity.
Gawande claims in the afterword that writing prose doesn’t come easily to him but you wouldn’t think it when reading this book. ‘Being Mortal’ is a very personal and affecting account – I read it about four weeks ago and I’m still thinking about it now. Highly recommended.