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A review by amyrhoda
Being Mortal by Atul Gawande
4.0
This is a book about aging and dying, and how our society doesn't handle those processes very well.
The two topics — aging and dying — are quite distinct. The first part of the book is about how to make aging better.
There comes a point in most lives, if we live long enough, when you can't carry on being perfectly independent. Maybe you need someone to change lightbulbs because you can't manage a stepladder. Maybe you can't wash your own hair because your shoulders are too arthritic. We don't live with our elders any more, so there isn't a youngest daughter or niece around to help, so we've tried to fix the problem by creating homes for the elderly. But those homes weren't ever designed with the needs of the elderly in mind. They were designed to open up space in hospitals — that's why they're called "nursing" homes.
Traditional nursing homes are organized to accommodate the staff, and to ensure safety. Everyone wakes up at the same time and is washed and dressed in time for breakfast to be served to everyone. Doors don't have locks, residents are not allowed to cook.
The problem is, no-one wants to live like that. Humans require agency and purpose. When you give people a door that locks, when you let them decide when to get dressed and when to eat, what to do and with whom, and when you give them something of value to do — look after a pet, tutor a child — they are happier, healthier, and they actually live longer.
The second part of the book is about end-of-life care. The most striking idea within, for me, is this: doctors can always do something. Before I read this I hadn't thought hard about it, but if I had I probably would have said that you start preparing for death when the doctors can't do any more to help you. But it turns out they can always try one more thing: an experimental medicine, another surgery, a drain here, a shunt there. Doctors can keep on poking at you until you go cold.
But if you let them keep poking at you, your last weeks, days, hours will be spent in hospital, fighting, full of tubes and wires. There's nothing wrong with that, if that's what you choose, but it seems that mostly people don't realize that that's what they're choosing. And often, they're not even offered a choice — you're dropped onto a conveyor belt when you receive a diagnosis, and no-one tells you that you can push the STOP button and climb off. You can choose to die at home, hopefully full of nice pain meds and home-cooked food, with your family and your pets by your side. Maybe a few weeks or months sooner than in the hospital — but maybe not.
There used to be something called "the art of dying". You were supposed to make peace, atone, connect with your loved ones, tell your stories. The art of dying lets your life come to a sensible end, like a novel, not just stop like a film with a broken reel.
If you are getting old, or expect to die, or love someone who is, Being Mortal is useful, moving, thought-provoking, and inspiring.
The two topics — aging and dying — are quite distinct. The first part of the book is about how to make aging better.
There comes a point in most lives, if we live long enough, when you can't carry on being perfectly independent. Maybe you need someone to change lightbulbs because you can't manage a stepladder. Maybe you can't wash your own hair because your shoulders are too arthritic. We don't live with our elders any more, so there isn't a youngest daughter or niece around to help, so we've tried to fix the problem by creating homes for the elderly. But those homes weren't ever designed with the needs of the elderly in mind. They were designed to open up space in hospitals — that's why they're called "nursing" homes.
Traditional nursing homes are organized to accommodate the staff, and to ensure safety. Everyone wakes up at the same time and is washed and dressed in time for breakfast to be served to everyone. Doors don't have locks, residents are not allowed to cook.
The problem is, no-one wants to live like that. Humans require agency and purpose. When you give people a door that locks, when you let them decide when to get dressed and when to eat, what to do and with whom, and when you give them something of value to do — look after a pet, tutor a child — they are happier, healthier, and they actually live longer.
The second part of the book is about end-of-life care. The most striking idea within, for me, is this: doctors can always do something. Before I read this I hadn't thought hard about it, but if I had I probably would have said that you start preparing for death when the doctors can't do any more to help you. But it turns out they can always try one more thing: an experimental medicine, another surgery, a drain here, a shunt there. Doctors can keep on poking at you until you go cold.
But if you let them keep poking at you, your last weeks, days, hours will be spent in hospital, fighting, full of tubes and wires. There's nothing wrong with that, if that's what you choose, but it seems that mostly people don't realize that that's what they're choosing. And often, they're not even offered a choice — you're dropped onto a conveyor belt when you receive a diagnosis, and no-one tells you that you can push the STOP button and climb off. You can choose to die at home, hopefully full of nice pain meds and home-cooked food, with your family and your pets by your side. Maybe a few weeks or months sooner than in the hospital — but maybe not.
There used to be something called "the art of dying". You were supposed to make peace, atone, connect with your loved ones, tell your stories. The art of dying lets your life come to a sensible end, like a novel, not just stop like a film with a broken reel.
If you are getting old, or expect to die, or love someone who is, Being Mortal is useful, moving, thought-provoking, and inspiring.