Being Mortal

The book Being Mortal (2014) by Atul Gawande a physician and surgeon at Harvard Medical School is a close up look at aging and death as it happens most often in the United States and much of the world today. However in this personal exploration of aging and death and how it is seen and treated under the care of modern medicine, and contemporary society, this book is equally a celebration of and re-framing of the goodness and meaning of life. Dr. Gawande shares stories of his own life, his own practice, as well as stories of medical colleagues and others who encounter or study aging and/or death as a part of their everyday lives. The writing is direct and honest, the stories touching and compelling, and uncovers much dissatisfaction with how both aging and death are viewed and treated in our times and culture. Dr. Gawande I think correctly identifies the core issues in recognizing that life is more than a breath and a heartbeat and maybe a few brain waves. Life is having a purpose, a sense of wonder, a sense of connection to other lives and a feeling of self-determination. These are all the things we as a culture have removed from being older and from our last days. Since the cardinal fact of our lives is that, as long as we live we will age and we will all die at some unknown time, it seems we spend very little time actually discussing and preparing for these transitions. As a psychologist I have lived much among the ill and the grieving and conversations about aging and death have been a regular part of my life for the past 30 plus years. Most people have some form of faith that has informed their lives and gives them comfort as they age and face death and would like for their faith to be honored as a part of their life and of their death experience. Most people hope to live connected to if not accompanied by loved ones. Most people hope to die without unnecessary suffering that cannot prolong a meaningful life. However, different people have differing values and beliefs and if we fail to honor the values of those we say we love or care for then what kind of life or death are we supporting for them? Most people hope to receive honest information about their health and prognosis for their life and death from their health providers. They want and need to be a part of the decision making about their own lives. I was asked many times to evaluate an older person to determine their competency to make their own life decisions; usually the referring family members or medical providers seemed to have the hope that I would find them incompetent so others could make easier decisions, that might foster safety but not life. Very often I came back with a much more nuanced and complex view that the patient was competent when given time and information and resources; they may need to be spoken too differently or have information presented in various ways and times and especially have a less emotionally distressed interaction with others, or more purposeful or pleasing choices, even if they might in fact be challenging or even a struggle; isn't that what life is, a challenge or a struggle? So my conversations over the results of such evaluations were actually easier when someone really was incompetent (which still didn't mean they were incapable of many things or understanding when care was taken). Put simply, this book is a masterpiece on aging and dying in America and while it offers critiques of how things are, it offers direction and hope for how we can all age and dying better. Dr. Gawande's book is a must read for any health care professional and is a great read for anyone else seeking to find better ways to think and talk about aging death.