Being Mortal: Medicine and What Happens in the End is a book by surgeon Atul Gwande. The book addresses end-of-life care, hospice care, and also contains Gawande's reflections and personal stories. Throughout the book, Gawande follows a hospice nurse on her rounds, a geriatrician in his clinic, and reformers overturning nursing homes.
Students were also presented with a case study regarding physician assisted suicide. We discussed this as an viable medical option to our elderly or extremely ill patients.
We are half way through the book and after a group discussion, these are our students thoughts:
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“Being Mortal” contains stories of elders holding onto their last grasp of freedom while their children balance between work and filial piety. Decades ago, the lives of the children centered around the lives of the parents; their duties would be to assist their elderly parents in fulfilling the activities in daily life. Decisions were made by the elders and the family’s role was to make it possible for it to happen. Unfortunately, modern day is not the same. More often than not, we can see how many elders are either forced into nursing homes or assisted living facilities either by their children or by the deteriorating state of their bodies. As they reach the phase in their lives when they are able to reflect on the past and begin seek comfort in the simplicity of life, it is too late. Even with all the technological advantages and medicine that we have created up to now, death is the inevitable end for every human being. Certainly, we have prolonged life, anywhere from a few hours to a few decades. But in the end, everyone dies. For the elders, because they know that their end is coming, they want to live their last years doing the things they want, the way they want to do them. Yet on the other hand, their own children are stopping them and taking away their independence. It is not because they don’t want to see their parents happy. It’s quite ironic what the children think versus what the parents think. Both want the same thing but they have conflicting approaches. For the children, they prioritize safety over independence, they want what they think is “best” for the parents. According to Maslow’s Hierarchy of Needs, safety is the second to bottom tier while self actualization is at the top. Perhaps that’s what the sons and daughters can not understand, that their parents have their own pride.
Then, there are those who do not wish to continue living longer when they are old. Some may choose to end their life sooner than when they are supposed to die. One of the methods they undergo when they feel that they have lived long enough or have fulfilled everything they wanted to is assisted suicide. This has been a pretty controversial topic because it depends on the situation, the patient, and the doctor(s). Sometimes, the patients are not stable enough to make their own choices, or the doctors, sometimes they might not be able to see what consequences might arise. My opinion on this topic is neutral because I believe that one law can not satisfy both sides since different people live different lives. In the case that the patient does choose to have an assisted suicide, I believe that the doctor should help them die a painless death and seek ways to give the family comfort and grief.
Hubert Galan:
I never truly understood the detrimental effect on the emotional state of a person when they are sent to an elderly home until I read ‘Being Mortal.’ Atul Gawande, the author, perfectly depicts the feeling of hopelessness and isolation many eldery people feel through the inclusion of anecdotes from his own patients and family. Moreover, Gawande invalidates the consistent perception that children who send their parents away are evil. I was able to gain a new level of empathy for not only the eldery people being sent away, but also the children, who are often drowning in guilt. In our discussion, we praised the book for giving a platform for eldery people to express how they feel, but criticized it for being repetitive. Gawande’s main focus of the novel was to discuss how physicians are trained to prevent the inevitable through medicine, despite the risk of increased suffering and death. As aspiring physicians, many of us had points of realization. Do we move forward with a medical procedure that has a low survival rate, or accept that death is approaching and minimize suffering? A question we never thought needed to be asked suddenly presented us with a dilemma. We left the discussion with a great amount of empathy and an even greater amount of confusion.
Connor Wall:
The book Being Mortal has made me think more about the nursing home system and the work that has been done to change it. There are different models of elderly housing that have different benefits setbacks depending on your point of view. Nursing homes for example offer systematic approaches to elderly living, where the safety of the person is the utmost importance and often outweighs personal autonomy. This makes nursing homes places where loved ones are generally satisfied but the actual incomes are treated as patients rather than people. Contrarily, assisted living homes are like real homes or apartments where groups live like any autonomous person would, only with the addition of a person who is helping hand who might perform medical analyses from time to time. Interestingly, an issue facing many western cultures is that these assisted living homes often evolve into nursing homes. In the US for example, elders are grouped together and forced to perform daily activities together. In this prison-like system, the physical health is made a greater priority than the mental health and as a result, mental instability can follow. Many experience depression, boredom and simply have no desire to live anymore without free will. By focusing on their patients physical health, these nursing homes often shorten the lives of their patients, whereas assisted living homes commit to the needs of its inhabitants. This makes assisted living homes all around better options economically, socially, and health-wise. The biggest issue however is that people forget about the mental needs of others and prioritize a limited view of health over happiness and would rather save resources without understanding if anything is actually being gained.
Abyhgaell Lachapelle
Being Mortal gave me a lot to think about in terms of how society views the elderly. I have never once gave thought about what it would be like to grow old and slowly lose not only your physical abilities but also your freedom and autonomy. I think that it’s something that I have taken for granted because it seemed too far ahead to concern myself with. In the book, Gwande includes the experiences of many elderly folks and what their process from being independent to ending up in some form assisted living course is like. One of them is his grandmother-in-law, Alice, who goes from living in her own home independently to having to turn to a facility that cares for the elderly after several unfortunate incidents. Reading her story made me think of what would actually happen to me when I grew old. I would always think about what I would do when my parents grew old but I never thought about the fact of what would happen when my time would come, and I really think that perfectly reflects what our society thinks of the elderly. How we often overlook them because as they age we slowly stop seeing them as people, humans who deserve respect and autonomy. This also plays into how the medical world sees the elderly; that they are only patients in which their safety is of utmost importance, and most of us don’t see anything wrong with that. Gwande reveals throughout the book that oftentimes these patients are not treated like real people in terms of respecting their privacy, boundaries, and abilities. I think that a lot of us don’t realize we do this with the elderly all the time. When we look back on our childhood, how limited our independence was and how we longed for the day when we would grow up, we may begin to understand how the elderly feel when they are disregarded by most of society.
This book made me see the elderly in a whole new light. For example, I thought the concept of ageism only seemed to apply to young people because I experienced it first hand. But as time went on, I began to learn more about the experiences of our senior citizens and the discrimination they face. I never knew about how many workplaces try to replace older employees with younger ones with no regard for that older employee's personal life. This made me feel more sympathetic to the olde generation because we are always taught to respect your elders, but we don’t even practice that. I hope that we as a society can work harder to create a more smooth and respectful space for the elderly to live out their last years.