Wednesday, 19 November 2014

Mortality: if you're mortal, this book should help. If you think you're not mortal, seek help....

This man (surgeon, researcher, teacher)

 Atul Gawande, has written a really important book. "Being Mortal" pulls together a lot of what many people have been saying for quite a long time: late and drastic medical interventions in someone's last days can be dreadful failures, in terms of what the dying person has to go through. He says a lot more than that, and he bases what he has to say on detailed accounts, including the last weeks of friends, and of his own father.

It's not always a jolly read; he goes into detail on the sort of ailments that are likely to afflict most of us as we age. One of his aims is to make us think and prepare for future difficulties, ours and those close to us; he wants to change how we view - or try to avoid viewing - the last  stages of life.

The book is about much more than medicine. He finds ways round the usual terrifying conundrums of the terminally ill, with regard to possible treatments. In doing so, he re-defines the role of doctors in such times.

Because a hospice nurse had sat down with Atul and his father and had a direct, careful sort of conversation, his father was able to surprise himself and his son with what he could still do.

"I was almosty oversome just witnessing it. Here was what a different kind of care - a different kind of medicine - makes possible, I thought to myself. Here is what having a hard conversation can do."

The conversation isn't about a menu of marginally effective and deeply horrible treatments; it's about asking the patient what matters to him, what are his fears, what is non-negotiable - all questions that acknowledge that he is going to die, and fairly soon. And then making the medicine serve those ends. 

It is very hard for doctors to do the best for a dying person if the person and those close to him can't acknowledge that they are in the last days, or weeks, or months of a life 

It's easy to say that the quality of a life is more important that it's length, at the end - unless, of course, it's your life. Here is a sensitive, emotionally honest, well-informed guide to a way through and round the horrors of futile (and very expensive) treatments. 

He writes with compassion and clarity, and he wears his learning lightly. It's a very, very good book about dying, so it's also about living.

Contemplating, through this book, the end of life has made my immediate life richer. Can't say fairer than that!

Atul Gawande is giving this year's Reith lectures, BBC Radio 4, 09:00 next Tuesday 25th November. Should be good.


  1. My goodness, you snapped this one up quickly! I've read lots of good things about it. It takes talent to make a topic like this populist and palatable. I shall fire up my Kindle and pluck it from the aether.

  2. I think you won't regret it Charles, even though some of it is the sort of stuff we have been chewing over for a long time. And yes, he sure is talented.

  3. On my list for Christmas, thank you

  4. You're welcome, Anon; I'm pleased to be spreading the word about this remarkable book. Though in fact, it's turning into a big success already. Impressive, for a book about old age and death.

  5. As you say, GM, a lot of what he is (reported to be) saying hasn't struck me as innovative. Yes, it's stuff we've been chewing over for a long time. But he has managed to break the ?_______? ceiling and reach the general public. Hats off.

    What would that ceiling b made of? Not glass, obviously. Erm...

  6. The only ceiling is the fog of our fears??
    I think what is innovative is the insight into different sorts of doctoring, and the practical advice he pulls out for us - and the way it is all rooted in specific cases, real people. I'm looking forward to his Reiths.

  7. Excellent Reith lecture this a.m. on BBC Radio 4, first of four.

  8. I only just got round to buying and reading it....wonderful book, as you say Gloria. I shall now try and beam up the Reith lecture. Cheers me dear!