Just Finished Reading: Being Mortal – Illness, Medicine and What Matters in the End by Atul Gawande (FP: 2014)

We all die in the end. No one should be any more aware of this than the author, a surgeon in Boston and professor at Harvard Medical School. But even he, with all his training and experience still struggled with the reality of death, its personal nature and our cultures rather perverse relationship to this most natural of events. More than anything, when death comes up close and very personal, he realises that the way we die is often far more important in what he thought was the primary function of medicine – to prolong life almost at all costs. It took a family tragedy with the diagnosis of his father with a rare form of cancer to make him realise that quality of life and quality of death is far more important than simple, and simplistic, quantity of life. So he did what any decent scientist would do – he investigated the phenomena, did his research and sought out the advice of experts in the field. What he came up with both surprised him and gave him hope that we don’t need to leave this world in a hospital bed, surrounded by strangers whilst being strapped to countless machines. There are other, better and more dignified, ways to meet our end.

Slowly realising that his profession, one he had joined in the expectation of helping people live long, happy and productive lives, was often the cause of rather than the solution to, a significant amount of pain and anguish was a revelation. Especially in the treatment of cancer we spend an inordinate of time, resource and money fighting something that, by its very nature cannot be beaten. More often than not, the medical profession will try drug after drug and procedure after procedure knowing full well that the prognosis is not good and that the odds of even recovering some functionality – never mind a full cure – are vanishingly small, and yet they try, not wanting to give up hope of a miracle and, to be honest not wanting to look bad. But giving false hope is, more often than not, worse than no hope at all. At least with the knowledge that time is short the patient can make their peace with the world and, plan their demise in the fashion that they would like it to go – with a brain not addled by aggressive chemicals and with, above all else, dignity and some element of personal control.

Using examples of hospices and organisations dedicated to allowing people to die in a way they choose rather than one which is done to them – no matter their personal circumstances, beliefs or needs – this is a deeply moving, sweetly sad and often amazingly uplifting book. One example struck me in particular. A new administrator at a nursing home wanted to try and improve the environment and did so by bringing in plants to add some much needed life into what was a very sterile environment. After that minor achievement he then persuaded the committee to allow several cats *and* dogs to be made available for residents to jointly keep. But he then pushed things further with the idea that each resident should have a bird – in their room. That was hundreds of birds. After much hard work and expectation of disaster the opposite happened. Patients who were on the edge of death got better, drug prescriptions dropped, life expectancy increased in spite of that and even residents who had not spoken a word in months began instructing the nurses about their birds needs and began offering to walk the dog. Then they had a crèche attached for the staff’s children and a nearby college was encouraged to send over students interested in caring for the elderly. Friendships across generations flourished and the nursing home became the very opposite of the sterile, lifeless place it had been before such a short time before the new resident doctor/administrator had arrived. If you had to die away from your family, for whatever reason, I could think of a lot worse places than one with the sound of children’s laughter in the corridors and the soft purring of a cat in your lap as you played a slow game of chess with someone less than a third your age trying not to be distracted by your stories of the decades before they were born. When the alternative is to end this life insensible on drugs and kept alive, if you can call it that, by machines pumping your blood and inflating your lungs long after they bought would have stopped in the natural order of things – well, it’s no real alternative at all is it?

This is most definitely a thoughtful and most thought provoking book. We’re all aging whether we like it or not. I don’t feel old most of the time but the signs are there. I’ll be 58 in a few short months so it’s no real surprise that thoughts turn in the direction of how things will end. The regular reminder of mortality when my heroes are starting to die off with all too steady predictability concentrates the mind in a way I never thought possible. Personally I’d rather go out laughing at someone’s off-colour joke than in a chemically induced haze that fogged the line between life and death so much that even I wouldn’t realise I’d died if someone didn’t tell me. Despite not exactly being a subject that we talk about, never mind think about much, this is an important book for everyone as we approach our own demise. Highly recommended.