Being Mortal Gawande Summary

Being Mortal

Inevitably so, we all experience aging in a way where serious illness or infirmity will occur. That being said, our self-reliance begins to fade and we become dependent on others. Whether we are taken in by our family and loved ones, or institutionalized in a nursing home, we sacrifice who we are as independents. Nonetheless, we give up the things we have worked so daringly hard for in life; our home, occupation, and relationships. In our times of old age, we face the most grueling of incidences. After reading “Being Mortal”, it becomes apparent that the employment of geriatricians and proper geriatric care is unmet. The attraction for many medical students is to get their parents’ satisfaction or earn a substantial income. Moreover,
most prospective students tend to diverge themselves from geriatric care. Physicians whom specialize in geriatric care do not receive a well-endowed income. However, it takes an experienced physician and problem solver to take on such a myriad of problems. With a younger population that is dissuaded from the field of geriatric care, we need a plan to solve this ever-growing problem.
Our medical system is so new and progressive that we simply cannot keep up with it. With the advancements in state-of-the-art technology and medicine, our lives have been substantially prolonged in the past century. Prior to this advancement, people were comfortable with the idea of death because it happened often. People suffered the most minor of complications with access to even the best medicine. Whether a case of the common flu, or advancing tonsillitis, death was fate and patients could settle on that. Historically speaking, the majority of deaths during WWI were due to untreated infections, not physical combat. In retrospect, we can scoff at this statistic with the inventions of basic antibiotics and vaccinations (i.e. penicillin and influenza vaccine). Since then, we have seen a positive correlation between life expectancy and advancing medicine. People live longer, but age in a way where they now become susceptible to a cohort of untreatable health problems. Doctors believe it is their duty to fix these problems. However, the troubling reality is how and when to draw the line and accept our own limitations. Often times, we find ourselves tackling an illness at the expense of the patient’s mental and/or physical suffering. For instance, a patient with terminal cancer could endure all the known methods of chemotherapy or radiation therapy just to obviate their own prognosis. If not that, worsen their state of health and overall well-being in the final moments of their life. That patient, now on a ventilator and feeding tube, experiences a load of regret if that can even be perceived. With a breakthrough of novel drugs and therapies, it is inevitable that such catastrophes should occur. It is in our nature as humans to strive and achieve survivability. However, poor prognoses should be managed in a way that is realistic to patient. Many physicians have been taught to be optimistic, which is how they should be most of the time. But when therapies are killing the patient at a rate that exceeds that of cancer, a physician needs to be attentive and uphold the decisiveness to cease therapy. At this time, foresight cannot be sugarcoated for the patient. The physician needs to be honest and convey the logistics with their patient. These are the geriatricians in demand. Geriatricians who are cognizant of a human’s limitations. Geriatricians who understand that quality of life is what matters, not how long you live. Geriatricians who can foster an environment of familiarity and purpose for their patient. Geriatricians who can provide guidance for the patient into their own passing. These are things that matter in life, and a we need to understand this.
As one grows old with frailty, the things that are held dear in life begin to shift around. When you are young, you seek memorable experiences, personal achievements, and meaningful relationships. These are few of the many goals we expect to accomplish (or attempt to accomplish) in our lifetime. Nonetheless, the idea is that we hope to maintain the things that make us who we are, and not to let the constraints of frailty and geriatric care strip these from our very hands. In other words, we do our best to keep our individuality and sense of self-purpose. This is the reason that geriatrics who receive nursing care do not do the tasks that they are obligated to do. They do not want to take a bolus of pills at a certain time, or deal with a roommate who keeps them up at night, or become entirely dependent on someone else. We reach a point in our lives where we accept our ending and want to make the most of the time we have left here on earth. We ignore our medical regimens and are concerned with the things that give us reason. It was addressed in “Being Mortal”, that a physician must provide the patient with all the facts and numbers, but then ask the patient what matters most to them or what they wish to achieve in their last moments. In the majority of geriatric cases, patients have gravitated towards quality of life over a prolonging of life. Life is like a story, and in stories, endings matter. There are ways we can ensure our personal ending is the one we feel is right; the job of the geriatrician and patient together.
Toward the end of the book, Gawande makes it evident his feelings about death.
He addresses to us that endings matter and that though we can have a long duration of steady pleasure, our remembering self will render the whole experience ruined if the ending is a bad one. Gawande understands that we see ourselves in our own stories, in that we strive for goals that are much larger than we are. That said, there are many ways that we can achieve such an ending. In the novel, Gawande talks about the introduction of animals in the hospital setting (dogs, cats, parakeets, etc.) and how they make the patients feel purposed. The patients are tasked with responsibilities such as caring for or feeding their animal, and they can note their animal’s progress. As an aspiring vet, I think attacking geriatric care from this angle is one we cannot overlook. Moreover, I think creating an environment without the depressing characteristics of a nursing home or hospital would help to fulfill a satisfying ending (fluorescent lights, double-bed rooms, tightly run regimens, the smell of antiseptics). It was also proven that replacing the word “geriatric” with “older adult”, would give such healthcare more of an appeal as “geriatric” has a negative connotation. Another way we could fulfill this personal ending of ours would be by maintaining our most personal relationships. Nowadays when loved ones are distanced, patients can touch base via Skype and other modes of communication. I believe if healthcare included means by which visits from family members were facilitated, I think this would help create our ending. “Being Mortal” engenders feelings of thoughtfulness in our geriatric healthcare system. I too have contemplated being a
geriatrician.