Monday 25 June 2018

Review: Being Mortal: Medicine and What Matters in the End

Part meditation and part call to action, Gawande’s Being Mortal is a compelling if depressing survey of the state of end of life care and why it matters to get it right. 

Essentially, in the West at least, we are in denial about death. So much so, that we and our doctors shy away from difficult conversations about what a good end looks like in favour of increasingly brutal interventions that often fail to do what the patient hopes they will do - that is prolong or restore life.

 When it comes to it, we all want to take our chances at being the one in the million miracle cure and focus on that rather than achieving what matters to us. What matters to us, often turns out to be surprisingly small. A previous high flyer may simply want to enjoy an ice cream and his favourite football game. Others focus on strengthening bonds with immediate friends and family.  All seem to hone in on the now, rather than the future. 

Equally important is what care in old age looks like. Again what we might choose for others is not necessarily what they'd choose for themselves. For example, they'd choose home and autonomy over safety. 

Most of the stories are saddening, and a few are heartbreaking. I was particularly struck by the story of one young patient who remained in denial up until and including her final words. 


Gawande pulls no punches in explaining what old age is really like. It is, as my Mum likes to say, not for sissies.  Essentially, it’s a slow wearing out of backup and then primary systems until you get cascade failure.  Terminal disease seems equally unappealing. Yet, one and/or the other is the trade off for being lucky enough to walk on this planet for a time.  All things considered, it’s not a bad one and demystifying the end process certainly made me think about what a meaningful (end of) life looks like.  


Verdict: Essential reading for anyone who expects to die one day.  

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