This might not be normal, but I think about death quite a bit. And about getting old. This is not depressing for me, or morbid. I just like to be prepared. There are a lot of things I can’t control about aging and dying—but there are certain things I can. By focusing on those things I can be as ready as possible.
So I have a deep appreciation for Dr. Atul Gawande’s book, Being Mortal: Medicine and What Matters in the End. For one thing, it’s a very readable book, probably because Gawande has filled it with stories of real people, real families, and real choices. Some of those stories are heartbreaking. Some are inspiring. All are instructive.
For another thing, Dr. Gawande’s analysis is insightful. He places the stories he tells into the context of the history of the American healthcare system, and in doing so he helps us understand why things are the way they are. Essentially, Gawande makes the case that as members of a culture that values independence, youth, and science, we are ill-equipped to face our own mortality—but it’s not too late to become better equipped.
There is so much good stuff that Gawande says in Being Mortal—the hardcover copy I have is full of underlinings that I’ve referred to several times in the weeks since I finished reading it. I’m trying to resist the temptation to over-share in this book review, but let me offer one short quote from the Epilogue. Dr. Gawande says:
We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. (p. 259)
This distinction he makes between “health and survival” and “well-being” is a central theme of the book. It’s a distinction you’ve seen played out if you’ve ever admitted a loved one to a nursing home. A decision like that is usually made out of concern for someone’s health and safety, and many nursing homes are pretty good at keeping people safe. Still, no one wants to go into a nursing home. Why? Because we know that life is about more than safety. Nursing homes can offer physical care, but what’s missing is the help we really need to navigate new reasons for living when our physical bodies begin to decline.
Normally a book like this might make me feel hopeless. I have a hard time dealing with systemic problems (like American healthcare) because they seem impossible to solve. But Gawande doesn’t ask me to change the system; he simply makes me aware of its shortcomings. In doing so, he helps prepare me to make my own healthcare choices, no matter what choices the system might pressure me to make. I don’t have to change the system; but I don’t have to let the system change me either.
Perhaps the most practical help Being Mortal offers is an encouragement to discuss four powerful questions before making any major healthcare decision—
- What is your understanding of the situation and its potential outcomes?
- What are your fears and what are your hopes?
- What trade-offs are you willing to make and not willing to make?
- What is the course of action that best serves this understanding?
By discussing these questions ahead of time with your family and with your physician, you’ll feel much more ready to face age, illness, and mortality.
Go ahead and order a copy of Being Mortal. I think you’ll find it surprisingly encouraging to read. It is neither manipulative nor indifferent. By the time you finish it, you’ll simply have a feeling of knowing what needs to be done and being ready to do it.
What more can you ask from a book about death?
Other things I’ve written about death: