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.

Read our student intern's insightful final thoughts below!!! They were made anonymous to give them the freedom to openly express themselves!!

Student 1

As I read through the book a question kept repeating through my head, What would you want from your doctor if you faced a serious illness?  As I read all the stories or experiences that other patients have gone through, I thought about what I would want if I was in there place. If I am being completely honest before reading this book I would take all measures of pain and treatments needed. Now that I have read the book I have begun to think that the problem is never completely fixed but just mediated for a while. I ask myself if I would truly like to go through the pain because I know that even if the doctors saved my life for a couple of months, in those months I know I would not be the same person. 

This book has also made me question my future as a senior. I always thought that I would grow old and have children that will take care of me. But as I read the book I started to realize that I am not in my country where it is automatically assumed that you’ll take care of your parents at home till their day of passing. I started to realize that I am in America where people are too busy to take care of their parents at home. So I began to fear that my children in the future will also not have the time to take care of me and so they’ll put me in a nursing home. But I thought about the example that I’ll set to my kids by taking care of my mother at home so that hopefully they’ll get the message that taking care of me would be the right thing to do."

Student 2

"How do we strike a balance between our fear of dying and hope for a long, healthy life, while still confronting reality?"

I consider that this is a very tricky question because the answer to it depends on how we see life and our understanding of it. In my opinion, for me to be able to keep a balance between our fear and hope for long healthy life will be the following: first, our body is a template and it should be taken care of. Finding a balance of what we put into it, such as eating healthy but if you have the desire to have a cheat day that’s also good, as long as it makes you feel good. Secondly, going out and enjoying yourself it’s also healthy for a human because we should be able to relieve stress by having fun. So for me, thinking about how to live a healthy and long life have many different factors because it doesn’t matter how healthy I eat or how much exercise I do if I’m never enjoying myself I’m back at no being healthy. Another factor could be mental health because the role that mental health plays in our lives is huge, if you’re not doing well mentally then “being healthy wouldn’t work at all. Thinking too much about how healthy I am could be stressful and can cause anxiety. So, therefore “being healthy varies from every person, because their balance to live a healthy long life will be different based on what they like to do in their free time.

Reading this book, emphasizes the fact that it doesn’t matter who we are if we are the richest person in the world or if we’re the poorest we are all going to die regardless. Now, I’m questioning myself, what is life? I never think about death often but I do think about how my life will look like in a couple of years and how a better life will be but I don’t really know what that means if I don’t know the true meaning of life.

Student 3

In the end of Being Mortal, Gwande proposes these discussion questions which I feel compelled to answer: “Have you ever seen anyone die or been with someone in the final stages of life? Can you describe that experience? How did your experience affect your wishes for the end of your own life?” I had the unfortunate experience of observing a loved one in her final stages of life. For her, it all started when she felt numbness on the left side of her body. She was admitted into the hospital and the doctors started running tests to see what was wrong. At first I did not think anything of it; I thought nothing was significantly wrong, but my concern kept growing each day she would spend in the hospital. 

A few days passed and the doctors finally had a diagnosis. She had an aggressive malignant brain tumor called glioblastoma. Although the doctors claimed it was incurable, I did not think so. I was hopeful that they would be able to cure her. The doctors performed surgery to reduce the size of the tumor and after she underwent chemotherapy and radiation. These treatments did not benefit her, but rather weakened her body more and more. 

She was not able to move her body or even talk. Most of the day, she would just lay in bed and I would be in the room with her in case she needed anything, but she never talked. She was admitted into a nursing home where there were nurses that could take care of her 24 hours a day. I would visit her regularly, even though my experience at the nursing home was not good. The nursing home had an overpowering smell of urine everywhere you went. The place felt quite unsanitary and I was reluctant to leave my loved one there by herself. The experience I had at this nursing home made me realize that when I get to a certain degree of disability, I do not want to be placed in a nursing home because I heavily associate it with desolation and unsanitary conditions. 

She was placed on life support due to her rapidly decreasing health. Even at this point, I was in denial. I did not want to admit that she was dying; to me, she was still alive. Now that I look back at the situation I realize that, although she was still alive, she was not living. Her children decided to take her off of life support because they wanted to stop her perpetual state of pain. This story in my life deeply moved me and prompted me to think about what I would want to happen to me during my last stage of life. One thing I know for sure is that I would not want to be kept alive if I am not actually living life, but I do not know yet what that means for me. At this stage of my life I am discovering, little by little, what it means for me to live my life.

Student 4

Doctors, and probably the rest of us, tend to define themselves by their success, not their failures. Is this true in your life? At work, in your family, at whatever skills you have? Should we define ourselves more by our failures? Do you know people who define themselves by their failures? (Are they fun to be with?) How can doctors, and the rest of us, strike a balance?

Yes, this is very true in my own life. I have developed the tendency to bury any sort of failures I may have experienced especially academically. People have this automatic assumption that I am this intelligent, academically perfect student - but this is just not the case. I have built such a high expectation for myself that when I don’t meet my intended goal, I automatically sort the experience as a ‘failure.’ I am working very hard to appreciate and learn from my failures. I don’t think we should define ourselves from only our failures or only our successes. There should be some sort of balance. I don’t think a person is a failure or a success, it is not that black and white. You should attribute your successes to your failures, and attribute your failures to your successes - if that makes any sense. I do know a few people who define themselves by their failures. Being a recently graduated senior, I have seen the disastrous effects that the college admissions process has on student’s emotions, egos and aspirations. Just because they don’t get into a certain school, they change their desired profession because they think they are not good enough or smart enough. This has happened to so many of my friends. It is saddening to see so many bright and intelligent students feel worthless because of the college admission process. Striking a balance, in my opinion, is very challenging. I think pride makes it so difficult to embrace failures. But, I think it’s such an important thing for people to do - especially mentor figures. 

Student 5

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.

Student 6

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.

Student 7

What did you discover about the physiology of aging? What is your attitude toward aging? 

After reading Being Mortal I became more aware of the physiological changes that occur during aging. I realized that it was not simply about the process of deterioration in our bodies but also about the battle against it as we try to carry out the tasks of daily life. Many of the characters in this book are living their later years in life with mental, physical, and/or emotional pains. To say that we become ‘weak’ when we get old is an understatement and misconception at the same time. Yes we do become physically weaker but it takes a lot of mental strength to strive through  living and dealing with these conditions. I think that my attitude of aging has changed, instead of fearing death, fearing the process of becoming old. The characters from the book allowed me to open up my eyes and see how the elders are treated by society and their families, and what they have to go through on a daily basis. Being Mortal lead me to view the elders in a more positive light and I feel more empathy towards them now.

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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.