Being Mortal: Medicine and What Matters in the End - Atul Gawande

My grandmother just turned 90 and lives on her own in the house where my mother was raised. She's lived there alone since her mother died at the age of 97, a year after my grandfather died of a massive heart attack leaving my grandmother a widow caring for her aging mother. At each step, my family has tried talk to my grandmother about her needs and moving into a facility with more activities and more people. She's very social. Up until this stupid pandemic struck, she was making crafts for the church bizarre and making tea sandwiches for the church coffee hour.

She's done amazingly well on her own, for a woman who had a heart attack ten years ago while visiting our family in Ohio. Since then she's watched her diet and makes her medical appointments through a car service for seniors. She takes trips to the grocery store or the mall. Sometimes calling a cab and sometimes taking the service. She hasn't driven since my grandfather's Chrysler needed a major repair decades ago. At each turn she's clung fiercely to her independence in a way that made little sense to us.

But now. Well now I've read this book and I feel terrible about the wasted energy of trying to convince a woman who raised two children and cared for her ailing mother and has made her limited income work for decades on her own, on the street she knows that I somehow known better what will make her life fulfilling. It would be one thing if she was complaining - or somehow making it known that her life was not satisfying to her. But she's not. She's shown, again and again, what it is she wants these years to look like for her, and the trade offs she's willing to make to have that independence in her life. So should we instead be looking at what ways in which we can make these goals of hers more achievable? Should we be aiming to help her live her best life now? Yes of course. Those are easy answers.

Being Mortal asks hard questions. The first half of the books looks at the way we treat infirmity and old age. And urges us to discuss what life looks like for our loved ones as they enter those sunset years. And really, what does life look like for ourselves? What things are essential to our being and self-actualization? It's so important to have these conversations and realize in the moment that we may be making choices based on our own preferences for our loved ones rather than what they would choose for themselves.

The second half of the book focuses on terminal illness and the limits of medicine. To what end do we continue to push our bodies past the point of diminishing returns? In the treatment of unconquerable illness, medicine will push us to choose the next thing and the next, often convincing us, against evidence, that there is always going to be a next thing. So when the final moments come, we are unprepared and the emotional toll on loved ones is enormous. Hospice services can enter the gap and make those last moments more bearable and better prepare us for their arrival. But of course no one is good at talking about these last moments. Doctors do not possess a natural ability to guide people in their end of life choices, unless they are trained and work at it.

I sometimes think awareness of an issue helps us take a step back from it and realize when we are in a situation that can sometimes be emotionally overwhelming. "Oh," we can think, "this is just like that book I read about making choices at the end of life." And maybe, hopefully, we can be better prepared to meet the next thing, even if it is the last thing. 

5/5 Stars.