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:
Maria Andrade:
Being Mortal by Atul Gwande is a book that is comprehensible, but also very difficult to come to terms with due to the realness of the writing. Gwande makes the claim that in our modern age, we are unwilling to accept that we are mortal beings and therefore when death approaches we are unprepared to face it. This, as I have read, can become a real problem in the medical field. Medical students are not being trained to treat people who are nearing death; in the words of Gwande “the purpose of medical schooling was to teach how to save lives, not how to tend to their demise” (1). This type of education is flawed because it is indirectly teaching that if someone is dying then we have failed him or her, especially since technology nowadays enables us to do so many extraordinary things. When a patient comes to the hospital with a terminal illness, he or she is often succumbed to undergo so many exhausting and expensive treatments just to end up with the same unwanted result. He or she is doing so with the support of doctors and his or her family members who are stubborn to realize and accept that death is inevitable. It can be so easy to write about this stuff, but I am certain that if I was in a situation where my life or the life of a loved one was on the line, I would also be the stubborn person I have just described. The truth is death is terrifying; nobody wants to die. This book has reinforced my belief that our biggest enemy is not an illness, but rather hope – hope that we can defeat death.
This book also sheds light on how poorly we treat our elders. Throughout the book, Gwande provides many anecdotes about the lives of a selective number of elderly people, which helps further emphasize his message. Where I come from the elders are venerated and it is common to live in a multigenerational home. While reading this book, it was unfathomable at first how the norm in the United States is to send the elders to a nursing home when they can no longer take care of themselves. However, I do understand that life is much busier here, so it is very challenging to care for them. Though I do understand the means of putting an elderly person in a nursing home, I do not understand why nursing homes are structured the way they are. Gawande brings up an important point about autonomy. Just like anyone, the elders want to maintain their autonomy wherever they are living. The loss of this independence can result in a loss of dignity and self. Nursing homes should stop worrying so much about the elders’ physical safety and start worrying more about their mental integrity.
Darla Castano
Reading the book “Being mortal” by Atul Gawande has made me realize that they way the medical system views death is as a failure. Doctors make absolutely everything in their power to help a person survive even if it means that their quality of life will be horrible and have to depend on machines or medications with terrible side effects. Furthermore, during the discussion I was able to understand even better the fact that death have been so medicalized that doctors and us, don’t realize the fact that one day we are all going to die with or without preventions from doctors. In fact, I believe that because death it’s seem as failure our arrogance as human beings don’t let us consider the fact that it’s something natural.
On the other hand, assisted suciced it’s a topic so controversial and at the same time is something that not everyone really talks about it. From our conversation on Friday, I was able to analyse and connect the fact that even if some people don’t think this is a good idea because of personal belief they do not have the right to decide for other people what they want to do with their body. Specifically, the fact that governors can ban what we can do with our bodies it’s so unfair because it’s taking our autonomy as a citizen and it’s going against the constitution because the 14th amendment states that the government cannot deprive a person from liberty without the process of law and I believe that a person should have the liberty to decide what they want to with their own bodies.
“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.