From the Bookshelf of Science and Inquiry…

Being Mortal: Medicine and What Matters in the End

Atul Gawande

Start date: November 1, 2015

Finish date: November 30, 2015

Discussion: Book Club 2015

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Book Club 2015

* December 2015 - Violinist's Thumb
By Betsy , co-mod · 32 posts · 87 views

last updated Jan 11, 2016 06:55AM

* November 2015 - Being Mortal
By Betsy , co-mod · 55 posts · 111 views

last updated Jun 25, 2016 03:15PM

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What Members Thought

Dec 07, 2014 Petra X rated it it was amazing

Shelves: medicine-science, 2014-reviews, popculture-anthropology, reviewed, 2014-read

This is brilliant. I'm having a good run of 5* books at the moment. Atul Gawande refers several times to The Death of Ivan Ilych so now I have to read that. I like it how one book leads to another sometimes. ...more

175 likes · Like · see review

Nov 03, 2015 David Rubenstein rated it it was amazing

Shelves: medicine

This excellent book is about how medicine treats patients as their lives come to an end. Today, Western medicine is all about keeping the patient alive, no matter the cost. The problem is that all too often, treatments at the end of life have limited value; they have little potential to prolong substantially, and even if they do, the quality of life is degraded significantly. Gawande, a practicing surgeon argues that the waning days of our lives "... are spent in institutions--nursing homes and This excellent book is about how medicine treats patients as their lives come to an end. Today, Western medicine is all about keeping the patient alive, no matter the cost. The problem is that all too often, treatments at the end of life have limited value; they have little potential to prolong substantially, and even if they do, the quality of life is degraded significantly. Gawande, a practicing surgeon argues that the waning days of our lives "... are spent in institutions--nursing homes and intensive care units--where regimented, anonymous routines cut us off from all the things that matter to us in life."

As the end draws near, some doctors go into an "informational mode". They give their patients a list of possible treatments, potential outcomes and side effects. It is really a mountain of information and very difficult for a suffering patient--or a family--to process and make a useful decision. Gawande describes a better approach. He writes about how some doctors will talk to their patients about their goals; realistic goals, given their illnesses. They take one or two hours to understand what is important to their patients, and then bring to the forefront a treatment option that will get them closest to their goals. The most important thing for every human is "... to retain the autonomy--the freedom--to be authors of our lives. This is the very marrow of being human." Terminally ill patients who had discussions with their doctor about end-of-life preferences were far more likely to die at peace, and to spare their family anguish.

Gawande writes at length about assisted living and nursing homes. Too often, these institutions seem to believe that their primary job is safety. But, fortunately, an increasing number of these institutions "... believe their job is not to confine people's choices, in the name of safety, but to expand them, in the name of living a worthwhile life."

So often, terminally ill cancer patients who had intensive interventions had a much worse quality of life in their last week, compared to those who did not have interventions. Moreover, six months later, their caregivers were three times more likely to suffer major depressions! So, Gawande describes the recent institution of hospice care. "The difference between standard medical care and hospice is not the difference between treating and doing nothing .... The difference was in the priorities. In ordinary medicine, the goal is to extend life. We'll sacrifice the quality of ... existence now--by performning surgery, providing chemotherapy, putting you in intensive care--for the chance of gaining time later. Hospice deploys nurses, doctors, chaplains and social workers to help people with a fatal illness have the fullest possible lives right now ... they focus of objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as feasible, or getting out with family once in a while." Studies show that patients who choose to supplement regular oncology treatments with palliative care stopped chemotherapy sooner, entered hospice care sooner, had less suffering--and lived 25% longer!

On average, doctors overestimate the time remaining for terminally ill patients by 30%. In addition, 40% of oncologists offer treatments they believe will not work! They worry about being too pessimistic, not about being too optimistic. Gawande describes experimental programs that give patients and their families a false hope. But these experimental treatments often have debilitating side effects with very little chance of working.

Gawande writes that our medical system and culture is built around the "long tail" of an improbable long life after a cancer diagnosis. The multi-trillion dollar medical system is the equivalent of lottery tickets. The problem is the system does not "... prepare patients for the near certainty that those tickets will not win."

Gawande adds wonderful personal touches throughout the book. Through a number of anecdotal histories, he traces the end-of-life treatments and outcomes. He even details the final months, weeks and days of his father's life. He shows clearly how much better it is for terminally ill patients to communicate with their doctor, to let their doctor understand their goals, get the right type of advice, and to understand when it is best to "let go". ...more

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Feb 22, 2015 Jim rated it it was amazing · review of another edition

Shelves: 2non-fiction, 1audio, favorites, science

This is very well read, amazingly relevant, & accessible. It's filled with real world examples as well as a few statistics. It is a must-read for everyone young (teens up) or old because we don't think about our end days properly or even ask the right questions. Worse, we don't understand what others are thinking or what their goals are.

- Doctors fix. If they can't fix, they often still try to do something. That's why they became doctors & have encyclopedic amounts of knowledge. Medicine has com ...more

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Dec 20, 2014 Mary rated it it was amazing

Shelves: science

A very informative book about the processes of aging, illness, and dying in America. Probably the most important book I will have read this year. It makes you think about the unpleasant possibilities of the future. How will I take care of myself in old age or during a serious illness. Your life can change in a second. Do you want hospice care? Rounds of chemo? Risky surgery?

Many good anecdotes to explain these possibilities. He includes the story of his father's illness and passing which points ...more

3 likes · Like · see review

Dec 28, 2014 Bel rated it really liked it · review of another edition

Shelves: non-fiction, health-and-medicine

I would say that this is pretty much essential reading for anyone who might get old or might get terribly ill, which is all of us.

Gawande is a surgeon who (rather humbly, I should say) leads us through his gradual realisation of what medicine should actually be trying to do when death rears its head: focus on what is important in people's lives. It sounds simple, but is easy to forget when focussing on fixing problems rather than the bigger picture.

There are several threads to this, and it was t ...more

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Aug 02, 2015 Jennifer rated it it was amazing

There was a time that I wouldn't think a book about dying a "good death" would rate any stars, let alone five, but things change. Working just one semester on an oncology floor has made me see things in a very different light, and this book does such an excellent job of discussing what has been taboo throughout most of the 20th and this century - that death comes to us all and so we need to face that fact with honesty and clarity about what really living means to us. Very recommended.

*This is wh ...more

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Aug 24, 2015 Kathleen (itpdx) rated it it was amazing · review of another edition

Shelves: non-fiction, lwv-book-group

An excellent, thought-provoking and kind of scary read for those of us in the senior category. The scary part was the description of how aging impacts us. Gawande looks at end of life medicine and care. The history was very interesting. I had not realized that the reason my grandmothers ended up in nursing homes is because in the 60s and 70s there wasn't much in the way of other options when their care overwhelmed family resources. The author finds a compassionate and practical way of discussing ...more

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Nov 24, 2014 Amanda rated it it was amazing

Shelves: nonfiction

I'm a big fan of this author, and this book didn't disappoint. The final chapter of our lives is not something most of us are comfortable thinking about, but this book explores the realities of what the aging and elderly in this country go through, and what we can do to make things better for ourselves and for those we care about.
I was skeptical when I picked this book up - honestly, I only started it because I've enjoyed the rest of Dr. Gawande's writing so much - but I'm glad I read it. I foun ...more

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