“Our ultimate goal, after all, is not a good death but a good life to the very end.”
― Atul Gawande, Being Mortal: Medicine and What Matters in the End
When I was fourteen, I fed patients pureed meatloaf one spoonful at a time, on the long-term care floor of a large urban hospital. The smell of packaged, thickened split pea soup will stay with me forever, as will my first moments of connection as a care-giver. What I also remember was the deep frustration and loss of autonomy that swirled around the diet warning labels on each chart, the bed rails safely up and locked, and the DO NOT AMBULATE signs posted above the beds. At the time, I didn’t recognize the anger that was often directed at me as a symptom of that loss. I just saw a stubborn elderly man who wanted to drink his morning tea without the thickening power we were required to stir in to prevent aspiration. His safety was a priority (and a liability) of the hospital, his doctor, his nurse, and myself, couldn’t he understand?
Since that early experience, I have cared for people of many ages as they lost the health and autonomy that often naturally precedes the end of life. I discovered that modern medicine, with its emphasis on safety and prolonging life as long as possible, often runs roughshod over the intangible uniqueness of the individual.
Last spring I read Being Mortal by Atul Gawande, and sat in my recliner during nap times, yelling “YES!” in my head while I turned the pages.
“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.” ― Atul Gawande, Being Mortal: Medicine and What Matters in the End
I put off reading this book because a piece of grass laying on a white page looks silly, not fascinating, to me. Also, a book about death? Not when I’m nursing a newborn, thanks. However, Gawande, a physician and surgeon, is insightful and engaging as he advocates that treating death as one more clinical problem often takes away the meaning and value of life as it ends. He writes clearly and weaves knowledge and insight between stories and personal experience. Instead of it being heavy, this book reads like a curious quest to discover what people really value in their lives and how we can help them keep those things as long as we can.
This was the book I wanted to give everyone to last year, but I’m not rich enough to buy a whole box of hardcovers and give them out for free. I do know someone in real life who did buy a whole box to give away to all their siblings, so you could do that too. If you read about books online you have probably already heard about or read this book, but in case any of my readers have not, I thought it worthwhile to recommend.
This book is not written from a Christian perspective, for readers who share my faith, but the concept of having a purpose larger than oneself and finishing life well are emphasized.
“The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days.” ― Atul Gawande, Being Mortal: Medicine and What Matters in the End
Most of us will become caregivers at some point and all of us will face end of life decisions for those we love and for ourselves. If we are not at one of these junctions presently, most likely we know someone who is. This book talks how to honor what people value in life and help them trade what they are willing to give up to keep the things they hold most dear. Compassion and honor would seem intuitive as we interact with those in their final years, but our own fears and concern for health and safety can hijack our empathy and cause us to override the wishes of those we are caring for. This book will decrease the chances that you will do that and give you more compassion for yourself and those you care for.
* I do ask that you do not read this review and go buy this book to give your terminally ill friend. I hope I don’t have to explain how insensitive and unhelpful that would be.