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Book Review

Being Mortal Medicine and What Matters in the End, by Atul Gawande, MD. Publisher Metropolitan Books, ISBN-13: 978-0805095159

Reviewed By Nate Hitzeman, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

YOU WILL DIE. I WILL DIE. We all will die. Given current trends in this country, you and I may die a prolonged death in the hospital or nursing home, on dialysis, or after courses of surgeries, chemotherapy, and radiation that may harm as well as help. As physicians, we encounter frailty and mortality on a regular basis. So why do we need a book about it? Yes, a quarter of Medicare dollars are spent on the last year of life, and mostly on the last weeks of life. Yes, we do not educate medical students adequately on the limitations of medicine, and how to guide patients through their inevitable demise. Yes, we do too many costly inventions with somewhat dubious long term benefits. So what does East Coast surgeon Dr. Atul Gawande tell us that is new in this book? I must confess that I am a big Atul Gawande fan, having read his New Yorker essays over the past decade speaking to geographic disparities in health care, waste in medicine, the power of checklists, achieving one’s personal best, targeting the “hot spotter” high utilizers in the revolving EDs, and more recently, the overkill we do in pathologizing what could be indolent cancers and processes. Being Mortal seems a culmination of Gawande’s journey as writer, public health researcher, and physician; accordingly, this book does not disappoint. As a surgeon, Gawande does not talk in the abstract. He’s analytical and concrete. He even includes two simple handdrawn graphs early on in the text to contrast the precipitous death of our ancestors with the slow sinusoidal death of modern day. He likes to dissect to the root causes of problems.

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He also has an appreciation for the history of medicine and the art of healing. He brings a cultural sensitivity as a second generation Indian American, and he radiates the intellect of a Harvard professor. Most importantly, he teaches by examples. Many examples. Through Being Mortal, we hear about his friends, patients, his daughter’s piano teacher, and ultimately his father struggling with their declining health and inevitable death. He weaves these examples into the framework of a history lesson on how society has dealt with the aged over the past century, from almshouses in the early 1900s, to the rise of hospitals and skilled nursing facilities in the mid-1900s postwar economic boom, to a counterculture of assisted-living experiments in the 1980s that sought to return some measure of independence to their clients – some having stayed true to their original vision, and many more now commercialized, diluted, or perverted. Gawande also shows us that surgeons and humility need not be mutually exclusive. He examines his own naivety about end-of-life discussions. He recounts his missteps with patients. There is no one-size-fits-all. He is reflective and intense in wanting to get better at this. He interviews geriatricians, patients, and community activists to see how docs can engage more effectively with their patients. Gawande brings up all of these issues without finger pointing. He acknowledges the complexities of deciding on how much care to seek for our loved ones. He also acknowledges the absurdity of our broken system with humor. He muses that if there were an implantable “automatic defrailer” device that could reduce

2015-Sep/Oct - SSV Medicine  

Sierra Sacramento Valley Medicine is the official journal of the Sierra Sacramento Valley Medical Society (SSVMS) and promotes the history,...

2015-Sep/Oct - SSV Medicine  

Sierra Sacramento Valley Medicine is the official journal of the Sierra Sacramento Valley Medical Society (SSVMS) and promotes the history,...