Atul Gawande on the realities we all must face.
Last week, I pitched Atul Gawande‘s latest book, Being Mortal, to my book club as a future read. It is an important book for everyone to read, I said. It would prompt lively discussion, I tried. Aside from one other who lobbied alongside me, the book was a tough sell to the group. And I get that. When you read blurbs that say this is a book about the “way we approach aging in America” and that it offers “important discussion on end-of-life care,” it doesn’t sound like a book that one might voluntarily pick up. And certainly not for a book club discussion, right?
Yet, I think this book could be more accurately titled, Being Human, because that is really what the book is about–not suffering, not dying–but the things we do to make us live. And how we could begin to have these conversations in our own families.
As Gawande points out, the way we manage elder care in the U.S. is to focus on basic sustaining and medical needs. In the case of a nursing home resident: is he/she well-fed, clean, pain-free, etc. But the questions we don’t always ask may be the more important ones: what are the patient’s likes/dislikes? What are his/her interests? What might inspire him/her to get up in the morning?
While there is no one-size-fits-all answer to each of those questions, there is one short answer to the larger question–what makes someone want to live? Put simply, it is having something to look forward to. That can be as simple as a visit from a friend, or a pet that shows affection, or even something as basic as a glass of wine (which traditional physicans might not permit on account of a patient’s medical condition). And in the end, Gawande seems to ask, will that last one really matter? (The answer might be yes–in that it will positively affect the individual.)
Those of advanced age also want to feel that they have some autonomy in their day-to-day decisions–just like individuals of every age (even, and perhaps especially, toddlers!). Imagine that you had someone come into your living quarters every day, give you something to eat (which might not be what you feel like having), dress you, and then have your schedule closely monitored throughout the day until you were told when to retire for the evening. Imagine too, that you were living in a shared space, where roommates could be dropped in and out at administrative will–and that you are taken away from every last bit of familiarity. Slowly, and steadily, you might disengage and decline.
That is not to say that some do need around the clock medical care, but for those that are dealing with the basic ills of old age, there may be some better solutions. Gawande profiles many innovators in the world of gerontology and social services that are doing it right. Like Bill Thomas’ Eden Alternative. Or Keren Brown Wilson‘s Park Place. Or Jacquie Carson’s Peter Sanborn Place.
Gawande also shares personal anecdotes from his and his wife’s own family experiences and emphasizes the importance of shared decision making between adult children and their aging parents. I strongly recommend this book to all–it offers a good reminder of the humanity that unites us all (young and old) and will help spark important familial conversations that should be happening long before they are a necessity.
Being Mortal is insightful and accessible while also being enjoyable. You will smile when you read the story of Gawande’s own grandfather, who at 110 was still taking the bus (!) to business meetings (yes, you read that correctly). And you will rally alongside Lou, the octogenarian whose best friend is an Iranian store clerk in his 20s. Read it, read it, read it.
And after you do, let me know what you think.