Being Mortal: Medicine and What Matters in the End

Atul Gawande

I believe strongly that doctors are women and men who work in a health-care facility of some kind, including hospitals, clinics, shelters, combat support hospitals, etc. Doctors, ahem, do not host talk shows. Medicine is a challenging, ever-evolving field of study and practice. One cannot be both a practicing doctor and a television personality.

That is, unless you are Atul Gawande.

On Feb. 10, PBS will break this rule when the Frontline documentary crew shadows the surgeon, author and New Yorker writer. The show is a tie-in with Gawande’s new book, Being Mortal, which chronicles the history and current state of end-of-life care, an issue that’s come to the fore through the proposing and passing of “death with dignity” initiatives in many states. Gawande takes us inside the nursing home, assisted living communities, to learn what these institutions are getting right and getting wrong, and to offer a view of the alternatives, such as hospice.

I have enjoyed most of Gawande’s writing, but I believe he’s surpassed his previous successes with Being Mortal. While his other books have been intimate and instructive, there is greater depth here that opens the author to his audience as never before. As the book progresses, it becomes a memoir, of sorts, of his father’s final years, a touching, factual documentation that delivers a bold-stroke illustration of his argument without overshadowing the narrative.

The focus of the book, however, is not on Gawande or his family. It is on the thousands of families struggling with end-of-life issues everyday. An indirect consequence of medical progress, Gawande argues, is that extending life has overshadowed sustaining quality of life, and in modern times, we have the luxury of distancing ourselves from our mortality.

“Technological society has forgotten what scholars call the ‘dying role’ and its importance to people as life approaches its end,” Gawande writes.

Being Mortal begins with a scholarly frame: the author calls up one of my favorite books, Tolstoy’s The Death of Ivan Ilyich, drawing attention to the relationship between the titular character and his butler, Gerasim. Without falling down the rabbit hole of Tolstoy’s existential treatise, the takeaway for Gawande is at what point do we stop pursuing cures (which agonized Ilyich) and provide comfort instead (as offered by Gerasim).

As Gawande puts it: “…it is clear that there are times when the cost of pushing exceeds its value.”

Defining when it’s that time is an uncomfortable topic, and as the author explains, it leads to many difficult conversations, but is important for the benefit of the dying as well as their caretakers.

The Frontline episode should be fantastic, as the show usually is, and will hopefully wean Americans off the junk food of television doctors Oz, Phil, et al. and snake-oil salesmen like Eben Alexander.

Instead of junk food, Gawande gives us science, history and heart in a page-turning treatise on the way we die now, and how we could do it better.