Being Mortal by Atul Gawande
This book includes insights from a doctor on his experiences with death and his journey to understanding the emotional influences, ethical considerations and empathy in regards to families and patients experiencing terminal illnesses and ageing. This book truly hits the realities of death, however morbid it is. He states that despite being a general surgeon and frequently giving bad news to patients, he is in fact still learning the arts of palliative care.
I found this book enlightening. Whilst on work experience I feel that a mere week in a hospital department doesn’t fully represent the doctor-patient relationships that are formed over months and all the social factors that contribute to it. The majority of doctors I have shadowed have been overly keen to show me what they love about their jobs, what facilities they have, explaining illnesses and treatments in their field, etc… (probably because they don’t want to hurt my aspirations to become a doctor) However there were a few exceptions where I saw the difficulties of delivering bad news, social factors such as drugs and emergency hospice service to patients dying in the next 24 hours.
It was only upon reflection after reading ‘Being Mortal’ that I began to understand some of the difficult and heartbreaking cases I have seen. For instance, whilst on cardiology work experience, I listened to a family speak about the implications of a pacemaker on the life span of their mother (who was also suffering from Alzheimer’s alongside heart failure). They took a breath of relief when the consultant stated that it wouldn’t affect her life span. The doctor later told me that the family were concerned as they didn’t want their mother to live a life of long-term suffering. Atul Gawande broaches the topic of choosing between length of life and quality of life, as well as the difficulties of finding a suitable middle ground.
There are many ethics and realities Gawande addresses, but here are a few that I want to highlight:
- Losing independence: as illness being stripping away the life that you have built and have grown close to so much, depression begins to take its toll. Starting small by not being able to make yourself a cup of tea, you brush it off thinking. This continues as other parts of your life begin to break down like your hand grip or your walking. To desperately keep hold of what you have always had and known, you keep ignoring it until something drastic happens… like a fall. The options social care can do for you such as care homes, despite their variety, they all have their down sides and nothing quite meets what you used to have. This is time when sacrifice of happiness couldn’t be more difficult.
- Courage: Courage to both accept the inevitability of mortality and the courage to act on the truth that we find.
- building a health system built upon what people want to achieve in their life rather than quality of treatments to build a more technological and modern health system: This is founded upon the difficulties people have working out when to allow nature to take control and to stop fighting. Instead thinking about how they want to spend the little time they have left. With new clinical trials of drugs and the huge variety of treatments, when a terminal illness looms over you it is difficult to not step away from another opportunity to live longer and push away that small hope – no matter the financial barrier, side effects or poor outcomes in statistics.
In all I would highly recommend this book (though it does require a certain emotional stamina – for me anyways). Those of you knowing that a career in medicine is for you this book adds to the crucial understanding that doctors are not always life-savers or there to be life-lengthening resources but rather they are there to support the fulfillments and aims people want from life.