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.
Themes
Mortality
The central concern of the book is how to best face human mortality. Modern medicine tries to vanquish death but of course cannot succeed at this task. But because mortality is not faced candidly, too many individuals suffer through procedures that don’t offer any real hope at prolonging life. Likewise, patients suffer by keeping their thoughts and fears about death bottled up, a requisite response since acknowledging mortality is often seen as admitting failure or giving up. Gawande imagines a better way, one in which modern medicine does all it can do in the face of illness and human suffering, while also admitting that frailty and death are part of the human condition.
Courage and Risk-Taking
Gawande states:
at least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortality—the courage to seek out the truth of what is to be feared and what is to be hoped. Such courage is difficult enough […] but even more daunting is the second kind of courage—the courage to act on the truth we find (355).
Throughout the book, Gawande notes the moments when he had or lacked courage, and when he was able to summon up the strength to have a difficult conversation with a patient, or, alternately, when he avoided it. He also credits patients such as Jewel Douglass with having this second type of courage. She was able to face her fate and make a decision based on the reality in front of her. Gawande’s father’s experience also provides occasion for the author to contemplate the true meaning of courage. Gawande admires his father’s courage, which prompted him to know what medical options were worth exploring and when it was time to acknowledge that nothing more could be done, save for enjoying the time he had left.
Risk-taking is also a prominent theme in the book. Gawande is critical of the medical establishment for undertaking risky procedures in the name of prolonging life at any cost. This ultimately is what Gawande feels he did in the case of Joseph Lazaroff. The surgery was risky and the likelihood of buying the patient more quality time from it was extremely remote. But because fighting death is the business of modern medicine, Gawande completed the surgery, which was a technical success but a failure for the patient. Risks taken simply to prolong life but not quality of life are not worth it, in the author’s view. Instead, patients would be better served by taking small risks, of the sort that Bill Thomas and Keren Brown Wilson built into their assisting living facilities. Being mobile or not constantly monitored maybe risky for some elderly patients, but it also contributes to their sense of autonomy. Having pets, plants and children in nursing homes might pose a risk, but the benefit of company and joy outweigh those risks.
Physical and Mental Health
For the patients profiled in the book, physical and mental health are interconnected. Controlling, round-the-clock nursing care may increase physical health, but it stands to be potentially dangerous to mental health if residents are treated as patients, rather than people.
Alice Hobson is a prime example of this. Her family places her in a nursing home to protect her physical well-being, but in the process, her mental health plummets. The living facilities pioneered by both Keren Brown Wilson and Bill Thomas try to find a balance between caring for the body and caring for the spirit. As Gawande reports,
Wilson said, ‘We want autonomy for ourselves and safety for those we loved.’ That remains the main problem and paradox for the fail. Many of the things that we want for those we care about are the things we would adamantly oppose for ourselves because they would infringe upon our sense of self (170).
Gawande admits that sometimes the elders are complicit in the damaging of their own mental health in that “they disperse the decision making to their children” (170). But the children are all too often neglectful of contemplating their elder’s mental health. Gawande again quotes Wilson, who notes:“It’s the rare child who is able to think, ‘Is this place what Mom would want or like or need?’ It’s more like they’re seeing it through their own lens. The child asks, ‘Is this a place I would be comfortable leaving Mom?’” (170). Gawande acknowledges how difficult it can be for children to let elders make their own decisions or to help elders make decisions that prioritize their mental health. The author experiences this challenge first hand when his father elects to not undergo surgery. But after seeing his father still mobile with minimal pain, he realizes it was the right decision to not impose his concerns for his father’s physical health over his father’s right to decide what would make him happiest.
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