Review: ‘Being Mortal’ by Atul Gawande

Metropolitan, 283 pages, $26

Three-quarters of the way through “Being Mortal: Medicine and What Matters in the End,” Atul Gawande pulls back his carefully stitched curtain of reporting and research to relate the story of his father’s decline and eventual death. Atmaram Gawande was in his early 70s when a tumor was discovered in his spinal cord. The diagnosis came, as all such diagnoses do, as a shock. He had experienced some neck pain and some numbness in his hand, which was starting to interfere with his urology practice.

A combination of strong medical care, thoughtful decision-making and luck had allowed Atmaram Gawande to live several good years, but eventually the disease led to paralysis and pain that was more than he could tolerate safely. After a middle-of-the-night fall that left Atmaram unhurt but unable to get up, it became clear that something had to be done. Yet Atul and his parents — all three of them doctors — weren’t sure what.

“We were up against the unfixable. But we were desperate to believe that we weren’t up against the unmanageable. Yet short of calling 911 the next time trouble hit, and letting the logic and momentum of medical solutions take over, what were we to do? Between the three of us we had 120 years of experience in medicine, but it seemed a mystery.”

For more than a decade, Atul Gawande has explored the fault lines of medicine, the instances when expectation grinds against the reality of practice. Starting with his National Book Award-nominated “Complications,” Gawande has combined his years of experience as a surgeon with his gift for fluid, seemingly effortless storytelling to remind readers that despite stunning technical advances, doctors are human — and as fallible as any of us. In “Being Mortal,” Gawande turns his attention to his most important subject yet: how our hypermedicalized culture is failing those who are at the ends of their lives, and their families.

Americans are optimists, and what place does death have in a culture of optimism? We focus on cures, not comfort. We wish 100-year-olds happy birthday on the “Today” show, but we don’t wonder whether their centennial days are fulfilling, or even pleasant — nor do we consider what could be done to make it so.

But Gawande does. He invites readers to join him as he considers “the modern experience of mortality,” setting the stage with a brief explanation of aging and a quick history of how earlier generations died — usually abruptly and at home. From there, he heads into nursing homes and explores the paradox of assisted living: How do you balance the often competing priorities of autonomy and safety for those who are too frail to live alone? Gawande offers portraits of families struggling with this question, portraits that are attuned to the nuances of intergenerational relationships that make this such a fraught subject. Gawande writes of a man named Lou who moves into assisted living after it becomes too much for his daughter Shelley to care for him: “After the move, he wasn’t angry with Shelley. But she might have found anger easier to deal with. He was just depressed, and what is a child to do about that?”

That notion of “a worthwhile life” is the central question of this book: How does each of us define what that means for ourselves? How do we communicate our wishes to those around us so that they can help us maintain a sense of purpose once we are unable to do so on our own? These matters make us flinch.

It requires a level of acceptance: Death is approaching, but there are still options that will allow people to live better in their final days — with less pain and fewer symptoms. These interventions won’t fix the problems, but they can allow families to concentrate on what’s most important at the end, to wring as much meaning as they can out of whatever time is left.

And yet the words “hospice” and “palliative care” are terrifying to some. One of the triumphs of “Being Mortal” is in its language. Gawande’s writing is clear and concise and yet gentle and humane. And most important, honest. He finds a way to talk about death and dying safely.

As masterful as Gawande’s writing is, though, “Being Mortal” is not an easy read. But it is essential.

“For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens,” Gawande writes. “And in stories, endings matter.”