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  • Writer's pictureArjun Patel

Being Mortal: Medicine and What Matters in the End - Part 1

Updated: May 20, 2023

I was always interested in what mattered in the end—was it your health, relationships, or children? When people die, what is the thing that mattered to them the moment before they passed? Was it remorse or nostalgia for what they had accomplished? Atul Gawande’s Being Mortal: Medicine and What Matters in the End is truly an inspirational book that I recommend to everyone interested in the difference between someone’s well-being and their survival. Would you rather someone be miserable but safe for their last years or happy yet at risk? These are all questions Gawande touches upon, and though I have only read half the book, his message is clear—spend the last years of your life focused on your well-being, and your happiness, instead of succumbing to a safe yet unhappy life.

He first begins with “Introduction.” Gawande remarks how he and his peers learned how to save lives in medical school, not about mortality and death. When going out to truly help people with medicine, Gawande and many others suffered from being unprepared to help patients face the possibility of death. Gawande talks of Joseph Lazaroff, who had metastatic prostate cancer, and he chose the risky surgery over the comfort care in hopes of getting better. Gawande explains that the procedure would never give Lazaroff the life he always wanted to live. Medicine allows people to live longer, but at what cost? I truly agree with Gawande here because medicine is not always going to benefit the recipient.

Next, Gawande starts “Chapter 1: The Independent Self” by talking about how his mother-in-law, Alice Hobson, loved taking care of her own home and living alone. Alice had become arthritic and lost some weight, so it was only a matter of time before she would have to move. Gawande’s father, Sitaram, fell and hit his head when getting off a bus, passing away at the age of around 110 years. Gawande talks about Alice's trip to the mountains where she became confused and went into the wrong cabin, fell down the stairs, and soon after, she had more falls. There was no long-term solution—Alice was becoming unsteady and her memory was slipping. This chapter is truly inspirational as it talks about how we cannot be independent anymore, and I think that that is a valuable lesson to learn.

In “Chapter 2: Things Fall Apart,” Gawande expresses how amazing medical advancements have become as people can live longer and healthier lives. Gawande compares life to teeth: dental care can help prevent the loss of teeth, but by the age of 85, about 40% of elders are toothless. Gawande talked with Juergen Bludau, a geriatrician, who talked about her first patient, Jean Gavrilles. Gavrilles had lower back and leg pains, arthritis, muscle weakness, poor balance, and more, yet with Bludau’s treatments, Gavrilles is now eating better and living comfortably. Alice had a car accident and was scammed out of $7,000 by two men, who eagerly took advantage of Alice’s old age. Her son, Jim, decided that it was time to put her in a retirement home. Felix Silverstone had a blind wife, Bella, and he retired to take care of her. He did everything for her—dress, feed, shower, and more. Felix felt that Bella gave him a sense of purpose in life. Gawande took both of them to dinner, and they choked on some food; luckily, they were both okay. In this chapter, Gawande talks about many people—Jean Gavrilles, Alice Hobson, and Bella Silverstone—and how their lives fell apart. All of their elderly issues led to problems, and this would soon lead to their downfall.

Gawande talks more about being dependent in “Chapter 3: Dependence.” Gawande talks more of Felix and his wife, Bella, who became completely deaf in the left ear. Bella has a fall another day and moves to a nursing home, where she can be better treated. Bella immediately hates it at the nursing home because the nurses did not do what Felix had done for her, and Felix ends up moving her back into their house. One day at lunch soon after her fall, she collapses and dies on the way to the hospital. Alice moved to an apartment and became sad, lonely, and depressed. Nursing homes were made to fix elderly people’s problems, but they didn’t account for one thing—the patient’s happiness. Alice grew more miserable and had a fall, yet she refused to move to the nursing home until later when she had another fall, breaking her hip. Soon after, Alice passed away. The lesson in this chapter is that the elderly depend on others to help them survive. Alice needed to be in a nursing home, and she may not have broken her hip if she had been there.

In “Chapter 4: Assistance,” Gawande talks more about the elderly needing more and more assistance throughout their lives. At 88 years old, Lou Sanders moved in with his daughter, Shelley, and her husband, Tom. Lou starts creating more burdens for both Shelley and her husband, and he starts falling frequently. They had to start shopping for assisted living homes, the in-between of independent living and a nursing home. Keren Brown Wilson, a gerontologist, wanted to create an alternative to nursing homes: assisted living homes. Laura Carstensen found that the elderly realize that they don’t have much time left, so they spend it with the people they know. The young have a long time to make more friends and fulfill themselves. Shelley found an assisted living home for Lou, yet it made him miserable. One night he drank too much and fell, and he started passing out more frequently thereafter. Shelley is forced to put him in a nursing home even though she knows that it will make him more miserable—she just wants him to be safe. The elderly constantly need assistance and I think that Gawande is trying to tell us to let the elderly enjoy their life because life is short, and it should be enjoyable and fulfilling.

I am halfway through Being Mortal: Medicine and What Matters in the End, and so far, I love it. Gawande's stories are remarkable, and I highly recommend that you check this book out. Part 2 will come soon with my outlook on the rest of the book, and I hope you join the growing anthropology community!

- AnthroManTalks

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