An IHE Book Review: Being Mortal

This would be a book I’d like to read on my deathbed.

Deathbed books probably isn’t something we think about but this book got me thinking about it.

‘Being Mortal’ helps us come to terms with the thought of death so we can have a better way of life because what I’ve come to realise from this book is that the end isn’t just simply existing, being fed and breathing, isn’t enough. What actually makes life worth living?

Life expectancy has come a long way since the middle ages. We’re lucky. Modern medicine is a marvel – open heart surgery, battling cancer and even fighting the ‘common’ cold – we’re living longer and better because of the advances we’ve made in the last century. But we haven’t quite come to terms with death and dying. “Scientific advances have turned the process of death and dying into medical experiences” – and so when medicine becomes all about patching up patients, you end up doing more harm than acknowledged.

Our decision making in medicine has failed so spectacularly that we have reached the point of inflicting harm on patients rather than confronting the subject of mortality 

In a series of brief, easy-to-read chapters, Atul Gawande covers the pros and cons of the many end of life options we have, backing everything with eye-opening research and gripping stories from his own family and his patients. We read about the way care homes are trying to make their care more humane instead of just focusing on the patient not getting hurt/ just being alive. Even things like being able to take care of plants or animals can improve a person’s quality of life so much so that in studies of programmes where caring responsibilities were introduced, residents saw the number of prescriptions reduced, especially those for agitation, activity and alertness heightened, and more importantly, death fell 15 percent.

It isn’t just transformative nursing homes like Chase Memorial (one of the ones mentioned in ‘Being Mortal’) changing end of life care for the better, but hospice care too. I’m privy to the thought that hospice care is just where you go to die. But that’s far from the truth. Those who did enter hospice care “suffered less, were physically more capable, and were better able, for a longer period, to interact with others”.  The results are stunning - less use of hospitals, ICU use dropping by more than two-thirds and less likely to undergo cardiopulmonary resuscitation – all because these people had the chance to have conversations with their doctor about their end-of-life preferences and die in peace, in control of their situation.

This is why the betrayals of body and mind that threaten to erase our character and memory remain among our most awful tortures. The battle of being mortal is the battle to maintain the integrity of one’s life—to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be. Sickness and old age make the struggle hard enough. The professionals and institutions we turn to should not make it worse. But we have at last entered an era in which an increasing number of them believe their job is not to confine people’s choices, in the name of safety, but expand them, in the name of living a worthwhile life.

And that’s what Gawande stresses in his book – medical professionals must be open to listening to patients and their wants to help them live during their last days. what is the basis of these conversations? Gawande highlights them when he had to speak to his father about his own end of life care after being diagnosed with cancer.

• What are our biggest fears and concerns
• What goals are most important to us
• What trade-offs are we willing to make, and which aren’t we willing to make

The reality is that the elderly aren’t much thought of in the medical profession. In their 2022 report, the Royal College of Physicians writes that “older people are the largest population group using NHS services, with over-65s accounting for almost 40% of hospital admissions. For many years, the recruitment and training of specialists in older people’s care has failed to keep pace with the growth in demand for healthcare from an ageing population.”[1] And so, although all of us know we don’t want to be sitting in a care home, infantilised, we just don’t have the people needed to help tackle an ageing British population in this country. But really, we need to make change. It isn’t just the enriched life people can lead but also the money saved. Palliative care saves money, relieves the burden on the NHS workforce and helps those in that care live longer.  

We pay doctors give chemotherapy and to do surgery but not to take the time required to sort out when to do so is unwise. This certainly is a factor. But the issue isn’t merely a matter of financing. It arises from a still unresolved argument about what the function of medicine really is …

You may be expecting this book to be doom and gloom, conversations about death tend to sway that way, but it isn’t. It’s kind of uplifting, in a way – the thought that we do have control over our futures. The end doesn’t have to be scary.

If you want to read a bit more on this, we found an interview with Atul Gawande and Mother Jones.

https://www.motherjones.com/media/2014/10/atul-gawande-being-mortal-interview-assisted-living/

Last year we ran the Healthy Ageing Challenge Awards to help fund a project focused on healthy ageing. Here's the four pitches, plus a summary of their projects.

Our Healthy Ageing work