33 pages • 1 hour read
Atul GawandeBeing Mortal: Illness, Medicine and what Matters in the End
Nonfiction | Book | Adult | Published in 2014A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Chapters 6-7Chapter Summaries & Analyses
Chapter Six Summary: “Letting Go”
Lou’s experience is very different from that of Sara Thomas Monopoli, who learns while pregnant at age thirty-four that she is dying of lung cancer. She undergoes chemotherapy, radiation and a series of medications that cause nearly debilitating side effects, yet it is apparent that time is still running out. Gawande contrasts these experiences with the hospice care offered to Lee Cox, who suffers from irreversible lung disease. Medication is offered to her but only to keep her comfortable, not under any pretense of cure. Similar care is given to Dave Galloway, whose pancreatic cancer was not able to be beaten back. Hospice care allows him to stay at home with his wife until the end. Because she is so young, Sara’s family holds out hope against hope that a cure will be found. After numerous rounds of chemo and radiations and more new, experimental medications, she contracts pneumonia, which kills her. Her death is drawn out and agonizing for Sara and her family and Gawande says that almost nothing done to Sara had achieved anything beyond making her worse.
Chapter Seven Summary: “Hard Conversations”
End-of-life care becomes far more complex for the author when it impacts those close to him. First, Gawande witnesses the rapid health decline of his daughter’s beloved piano teacher, Peg Bachelder. He can tell from conversations with Peg and her husband that they are angry and overwhelmed. The leukemia treatments Peg had been undergoing are no longer helpful and few options remain. Rather than exploring last-ditch options, Gawande convinces Peg and her husband that being at home is best, with nursing support to aid them. Because Peg goes for this option, she is able to spend her last days surrounded by her family and students. Gawande’s daughter and other young pianists participate in a final recital in Peg’s home before she passes.
Shortly thereafter, Gawande’s father’s health starts to decline. An MRI reveals a tumor growing on his spinal cord. In a consult with one surgeon, Gawande’s father is informed that before long the condition would render him quadriplegic, perhaps in just weeks. Gawande’s father decides not to undergo surgery and instead deals with the symptoms as they occur, such as pain and numbness in his hands.
Around the same time that Gawande’s father is dealing with initial complications of his tumor, the author begins to treat Jewel Douglass, a seventy-two-year-old woman with metastatic ovarian cancer. In his conversations with Jewel, Gawande attempts to be informative, rather than prescriptive, in his care, using terms like “I am worried,” instead of telling the patient what to decide in regard to her terminal condition. Though Jewel is initially horrified when Gawande makes it clear that her reality cannot be changed, later, she is grateful for their talk. It allows her to make healthcare decisions that leave her mobile enough to travel to the beach and attend a family wedding. Gawande’s father’s decisions also allow him to be active for as long as possible—playing tennis, writing, and remain part of his Rotary Club. When Gawande tells his father “I am worried,” his father decides to undergo surgery and then radiation afterwards. Despite this, the tumor continues to expand. Gawande’s father then decides to stop discussing his symptoms at length. He makes mobility his focus. Though he is rapidly declining, he is able to attend a convocation at which his son is the speaker.
Chapters 6-7 Analysis
Gawande relays the story of Sara Monopoli, a woman diagnosed with advanced lung cancer while still in her thirties. Her condition is treated aggressively, with multiple rounds of chemotherapy and radiation, as well as surgery and new and experimental medication. Her family is unable to accept the likelihood of her passing and encourages her to undergo every possible method of potentially vanquishing cancer. Sara ends up dying an agonizing death, weakened by all the rounds of chemo and radiation and struggling with her medication’s side effects. Gawande compares Sara’s experiences with those of Lee Cox, a seventy-year-old with advancing lung disease and a host of other conditions. Cox is given palliative care and remains largely independent and mobile. Dave Galloway, a cancer patient in his forties, receives hospice care as well, forgoing invasive medical treatment, and is able to stay at home with his wife until the end. Gawande uses Galloway’s experiences as evidence that hard conversations about death can yield a more positive outcome for both the patient and the family. As he states, “In other words, people who had substantive discussions with their doctor about their end of life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish” (273). Gawande regrets that Sara and her family did not engage in this and that he did not do more to facilitate this kind of conversation, as difficult as it might be.
When the author’s father becomes seriously ill, the issue of end-of-life care becomes even more emotionally fraught. Gawande’s father is diagnosed with a spinal cord tumor. His father opts to forego risky surgery that offers uncertain benefits. Watching his father interact with his doctors allows the author to reflect on his own bedside manner. He realizes that in the past he has eschewed being a paternalistic doctor who makes all the decisions for the patient but feels that his informative approach, in which he outlines options without commentary, is also not enough. He resolves to try for more of a guiding voice going forward, offering not just options but asking questions about patient’s hopes and fears in order to map out a productive plan.
He tries this out first with a patient named Jewel Douglass and through their conversations they are able to maximize the time that remains for Douglass and avoid risks she does not wish to take. Gawande admits:
In my career, I have always been most comfortable being Dr. Informative. (My generation of physicians has mostly steered away from being Dr. Knows Best). But Dr. Informative was clearly not sufficient enough to help Sara Monopoli or the many other seriously ill patients I’d had (311).
With Jewel Douglass, Gawande begins to turn over a new leaf. When he presents Douglass simply with options and no commentary on them, she is upset and overwhelmed. But when they talk together about what she still wants to accomplish (such as going to the beach and attending a family wedding) Gawande is able to get aclearer picture of what matters to Douglass in her final days. Though she doesn’t get to do everything she’d still like to do, she and Gawande do decide to undertake an intermediary surgery rather than a riskier one. This gives her some physical reliefs from her symptoms without any pretense of a cure.
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