Being Mortal: Illness, Medicine and What Matters in the End (Wellcome Collection)

I thought I once picked up this book and it contained the quote by Bette Davis saying ‘old age ain’t for sissies’ which I loved. I also thought it contained another quote about who wants to live to 99 with a whole range of health problems that might include poor eyesight and hearing loss, on a dialysis machine and taking every medicine under the sun just to keep breathing - answer; the person with all this who is aged 98. However, neither of these are in this book so I thought I would add them to this review. I love both those quotes and would love to know what book I did actually read these quotes from. - In this book the author, Atul Gwande (a man someone should make a saint) has written a book about death that is full of hope. He looks at how we can better manage and have a good death. Previously most of us died at home but now the majority of us die in hospitals attached to drips and adding to the prolonged memory of end-of-life care. - Man has spent most of the 200 - 300,000 years of existence on this planet, with an average life expectancy of living to the ages of 30 or 40. It is only in the last century that we start to live in longer lives and move from living to an average age of 30 or 40 to an average age of 70 or 80, and our bodies have to adjust the fact that we are ageing and this is not necessarily a natural course of events but we are kept alive for these long periods of time for many people through medicines and healthcare and understanding how we can do this. However, do we really want to then end our final few years separated from loved ones, living in an institution and buried by a mass of tubes keeping us barely conscious. - This book is a fascinating look at how we view ageing and how we might wish to end our days or those of a loved one. Ending up in an institutions such as nursing homes have been likened to a similar institutionalisation that you would resemble prisons or mental facility for people with mental health problems, it's not dignified, it's often neglect where old people lose all the sense of dignity that they may have had whilst being independently living on their own, and be given nightdresses and institutionalised clothes with wardens going around making sure you behave in a certain way and do the right thing and end up being treated like a child or someone beneath them. Just because you're in an institution where you are cared for and there is a lot of care going on doesn't mean that they can make you fit in with scheduled events and where everything is regimented once they have your money. - However if the alternative is to put the black the burden on a family member such as a daughter who is usually in often is, then they are now the carer and provided medicine, providing meals, and having to deal with people alongside their house rules. So the emphasis of care provided by a carer can be equally bleak and difficult on both parties such as the family member and the older person who requires care. - So if we don't like institutions and we feel we can't put the burden of care on family members, what is the solution? Another idea suggested is assisted living where people have their own houses and their own privacy, dignity and ability to control but also have the opportunity to meet other people, and have basic care when provided and necessary. Old people aren't called patients but are known as tenants and in this setting might be a better alternative. Even when people are old and frail and possibly losing memory and some faculties, we still need to ask the question: what is it that makes life live it worth living and what is a good life even when we might have other areas of concern and be old and frail. - Rachel Carson was somebody who looked at Maslow's motivation of needs approach and noted that actually it was how perspectives can change for older people because they have a different perspective on life than younger people do. When young, you feel they're going to live forever and you're motivated by work goals and making a career. But as you age, your perspectives change - many people get less depressed and feel the more important things are close relationships with families and friends. Your days are limited, you become aware of the fact, your perspective on what’s important changes. In fact, how we perceive everything can help us lead better lives. - However many of the institutionalised independent living places really turned into more like institutions. For what is a better life after all many of these frail people suffer from the three plagues of boredom, loneliness and frailty so could we turn places such as nursing homes into something that tries to manage boredom, loneliness and helplessness? The author also looks at life and what it means that we have to care and be connected to one another and we'll see what will happen to people even after we die. There are very few people that would ever want to imagine that when they die, an hour later everyone else would be wiped off the planet earth, we care what will happen to people after we've gone and for some, dying is the gift that they can help those left behind feel better about the death of a parent or loved one. - The book then switches to a young mother who is giving birth to a baby but through that operation they discover that she has lung cancer and it is terminal. She is a non-smoker (note: 50% of people who have lung cancer are non-smokers). She was then given several courses of treatment and to which she will still probably live no more than a year. The question is what kind of care do we want to give to people who are in the final year of life as 25% of all Medicare in America is spent on people who will have one year left of life and the majority of that money will be spent on the last two months of care before the person dies. Often when people are in the final years or stages of an incurable disease the questions we should be asking are what would they want from this life at this time and what is important. The answers are often creating understanding or close relationships with the people in their lives, filling their lives with some meaning and closure and it's not necessarily about keeping them alive pumped full of drugs, in and out of consciousness in a hospital bed, sent via tubes and barely registering what's going on. However, we don't ask these questions and we should think, is this how I really want to spend my final weeks or days in this way. - End-of-life care in terminally ill patients who particularly might have less than a year to live, are often under the management of doctors who continuously try to find something that might extend life by a few months rather than the years they expect. Many patients think further treatments might extend and offer them an extra 20 years of life when in actual fact almost all statistical evidence says that it might give them all three months. When patients are then given palliative care from trained nurses who without the need to stop curative care they can often form better decisions because people start asking them what is important in their life and help them to understand the realities of what is going to occur. Fascinating stuff that we should think about. In many societies where palliative care is the norm rather than further courses of treatment - particularly in countries that don’t have access to the medicines available in America - life expectancy is often longer than those on relentless courses of expensive treatments. It reminds me of a joke in regards to why they stick steel nails into coffins of people who have died of cancer, it's to stop the oncologist coming up with one further bout of treatment. After reading the account of one young lady's decision-making and the whole family's inability to accept what was going on, her life's end of life care was just one about an excessive set of treatments without necessarily looking at what is the best way to die. These are questions we need to be asking ourselves. And palliative care nurses could be the best people to do this. - What is also interesting is the end of life care in regards to hospice treatment actually seems to have longer life expectancy than the care that has just given through medical intervention, not by years and only weeks or months, but also it may lead to a better death - If we have to face bad news we also have to think about what we want. Do you want the doctor to inform us about the best medical decisions we can make or do we want the doctor to listen to our fears and try to manage that and address those fears. Hope that a better way would be to give us information and guidance but also try to help us make the decisions that we need to do so even a model of that is listening to the patient, giving advice but tempering that advice with what our fears and needs actually are within relation to possible surgery or further treatment. And I guess it's important to remember that lots of medical practitioners just want to try and fix a problem and those conversations are hard. - Though Gawande tells many stories in this book - he also talks of his own experiences and of his own family (particularly his dad and grandad). It really helps to crystalise the message that he is telling with this book. - I love the author's approach by starting with three words when you want to relate and discuss something that might be hard to tackle, and those words are "I am worried”. - The most amazing thing about this book that is about death is that it's also about a better life to gain some insight and solutions to how we can die - and as Jim Morrison once sang “no one here gets out alive” so it's worth asking these questions now rather than waiting until it's too late. A recommended book on death that tells us a lot about how to live.

This was an incredible book and long needed. Having experienced the death of close ones I can only wish their care had been in line with some of what is presented here. Too often life is over medicated when what we need is understanding and empathy. Every doctor should read this book. If you have any concerns around end of life care then this is a superb book to help inform some of the most difficult decisions we face.

Recommended to me by a wise GP friend of mine and an empathetic therapist, 'Being mortal' is well worth reading no matter what your age and life circumstance, but especially, I would suggest, if you're dealing with elderly parents or relatives, or are in the latter stages of life yourself. The first half of the book focuses perhaps more than I would have wished on different forms of residential care for the elderly; not that this wasn't interesting, but it is very US focused and detailed. I also felt that it was a big omission not to talk much about mental health and the elderly; fading memory, anxiety and anger, for instance, are very common in those who are ageing yet were barely mentioned. This emotional minefield can make relationships with spouses, offspring and carers much more fraught when trying to negotiate how and where to best to live as we age. These reservations aside, the second half of the book saw Gawande hit his stride. Here I felt he abandoned his more measured perspective, (borne, probably, from being a scientist and medic) and stepped into breach. Drawing upon his own experiences with his father – with an honestly and courage I found very moving - as well as the experiences of other patients and people he knows or has known, he writes with passion and clarity about the final stages of life, decisions need to be taken, and how to each individual might find a way through. Both useful and insightful, it's for this second half of the book I would roundly recommend it. Several times it moved me to tears, and even more frequently made me think how what was being described relates to my own loved ones. I'm sure it will prove useful in dealing with my own elderly parents, and others would find likewise. Who knows? I may even find it useful when it comes to my own end of life, though I may well be depending on others to ask those all important questions when I get to that point.

Such a brilliant book written with such compassion and deep understanding.

El tema es muy importante para todos. Nos ayuda a ver con nuevos ojos cómo enfrentamos las enfermedades y la vejez.

This is probably the most important book on mortality I've ever read. It is packed full of information and written in easily comprehendible language, in fact, very personal language. There is so much information here I had a hard time reviewing as I want to share it all! Promise, I won't, but will try to stay with just a few important highlights. First, this book looks at nursing homes and the rise and fall of assisted living. You may think, what? We have assisted living. But, for a short time after people no longer simply died at home, assisted living, through the hard fought battles of one woman in particular was available to all patients. Now the primary goal of safety has once again given us nursing homes. Assisted living is mostly for those with the money to afford it. This need for safety has left many to languish at places no different than former asylums. This so called "life" is devoid of any purpose to live, and actually increases death rates. This book then goes into the medical profession. The focus here is on repair, how to fix, what medications will work, when is surgery necessary. The only problem is that the medical profession has no idea how to talk to people, and is even discouraged from doing so. Most doctors have not had a single course in geriatrics. What to do with an old person? Amazing that we have no sense of our own mortality. Now 25% of Medicare spending is for 5% in their final year of life, with very little benefit. A great quote was "We imagine that we can wait until doctors tell us there is nothing more they can do, but rarely is there nothing more that doctors can do." So this instance of survival at all costs has left many to die in a hospital with tubes everywhere, fading in and out of awareness. This of course leaves no chance for good-byes, even "I'm sorry" or "I love you." What it really comes down to is a few important questions. I loved the ones provided in this book. "The biggest questions to ask are, what are your biggest fears or concerns? What goals are most important to you and what trade-offs are you willing to make, or not make?" Another topic was hospice. I assumed hospice is only for the final end of life, but it is not. Hospice is available at any time, and the focus is on a person's wants and needs. Many get better after a stay, and leave, some even return to work! Incredible book. Atul Gawande is a physician who I believe has written a most timely and important book. He provides an inside look at medicine, a historical perspective on dying, the most recent surveys on cost and care options and so much more. He comes from his own experiences and clearly his research has changed his own outlook on mortality. A must read. Highly recommended!

Es un libro que está escrito desde un punto de vista muy humano, a la vez que realista, estos dos factores, unidos a una prosa sencilla y clara hacen del libro un antídoto contra el miedo a la muerte, al menos es el sentimiento que produjo en mí que ya tengo 85 años.

Wer sich - aus welchen Gründen auch immer - konkret mit Gebrechlichkeit, Alter, schwerer Krankheit oder Sterblichkeit auseinandersetzen muss, ist sehr gut beraten dieses Buch zu lesen: Der Autor ist kompetent, erfahren, reflektiert und schreibt einleuchtend, eindringlich und einfühlsam sowohl über die Mängel und die Ignoranz im professionellen Umgang mit dem Nahen des Todes als auch - an eigenem familiären Beispiel - über unsere unausgebildeten Emotionen und unsere Hilflosigkeit als Betroffene. Kurz: "Being Mortal" ist auf höchstem Niveau emphatisch, bewegend und informativ zugleich.