Thursday, 26 May 2016

Being Mortal

Tina Vajpeyi reviews the book Being Mortal by Dr Atul Gawande

The world over, medical professionals are taught how to cure people and how to keep them alive. No course provides in-depth or extensive training on how to handle those who are dying and in particular, elderly patients who are nearing the end of their lives. Anywhere in the world, the percentage of doctors specialising in geriatric care is minuscule.

The ‘do no harm’ principle that is a cornerstone of the medical profession means that doctors are not supposed to determine how and often when, a life ends. Unfortunately, most relatives and friends are not prepared to have those conversations with doctors, or even amongst themselves. Nor do any courses teach doctors how to talk about such issues with patients, their families, friends and care-givers.

Written in fluid prose, best-selling author Dr Atul Gawande’s book, Being Mortal includes research and analysis into elder care and discusses what matters most to people as they age and become physically dependent, and encompasses various thought-provoking perspectives on the subject.

Drawing from his decades of experience as a surgeon and writer-researcher in the West, and the experiences of his family in India, Gawande compares and discusses the two varying scenarios. In India, until recently, it has mainly been the extended family that cares for the elderly, whereas in the United States, elderly people are mostly being cared for in privately-run, assisted-living facilities or living independently, for longer periods of their lives.

The book provides interesting statistics to explain the changing dynamics of family as technology and healthcare improve. In the US, for example, only 17% of the elderly now die in their own homes; whereas it was once the norm to pass away peacefully at home, death now often occurs whilst a patient is connected to machines in an ICU, in a hospital bed or while living in a nursing home.

The book also dwells on how medical insurance, advances in medical technology and treatments, and improved healthcare are changing attitudes about, and the dynamics of, mortality. More and more people are now trying to live longer, irrespective of the quality of their lives. The author highlights the dilemmas that people grapple with when confronted with aging, illness and imminent death, and provides examples of how both families and patients themselves have made difficult decisions.

While the west has been addressing the subject of home care and retirement living for some time now, more traditional societies like India are less prone to do so because of ingrained family mindsets regarding caring for the elderly and also, a generalised avoidance of open and informed discussions about what matters most towards the end of our lives.

While all doctors and those involved in caring for the elderly – family or organizations will find this book immensely useful as they confront the subjects covered by it daily, Being Mortal really is a book for everyone, since it deals with ageing and mortality, a fate none of us can escape. And its language and treatment of its subject is such. Accessibly written, analytical and provocative, it will make the reader think about healthcare, treatment and end-of-life issues that they ought to consider as they age. 

Dr Atul Gawande
Dr Atul Gawande is the author of four books, all of them New York Times best-sellers, including his latest, Being Mortal. He is a winner of the Lewis Thomas Prize, awarded for science writing, and two National Magazine Awards. Complications, Better and A Checklist Manifesto are his other works. A surgeon by profession, he practices at Brigham and Women’s Hospital, Boston and is a professor at Harvard Medical school and Harvard School of Public Health, and a public health researcher. He is also Chairman of Lifebox, a non-profit organization making surgery safer globally. 
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