Being Mortal

***/*****                                                                                                           Nonfiction/Science/Life

Being Mortal: Medicine and What Matters in the End

Atul Gawande

Homo sapiens probably are the only species of animals where individual die of old age, except animals kept in captivity. Animals of other species rarely reach debilitating old age, as long before this they succumb to disease or predation. Nature has no use for individuals who cannot reproduce any longer. Perhaps this is the reason that accidental mutations in human genome that code for healthy and long age are not selected by natural selection. Thus, old age in human beings is an exception in the animal world, an artificially created entity, product of our intricate socio-cultural milieu that generates our value system, wherein to look after old relatives is considered a most exalted moral duty. Breakup of joint family system in modern society has made it difficult, even for willing people, to fulfil this obligation. Few misfortunes in life are as heartrending to witness as the misery of an old, decrepit destitute whom life in its final days has denied even the barest pretence of human dignity.

Atul Gawande is a surgeon in USA. In this book he examines the issues that matter in life as one gradually but surely nears his end and whether modern medicine even attempts to address these. Ageing robs people of the capability to carry out chores of daily living, both mental and physical. Most individuals and medical science too, feel that assistance in these affairs is all that an old person needs to make his life meaningful. Thus, all their needs are objectified. Old-age homes categorise occupants based on the level of assistance they need. This leaves no scope for subjectively varying the care or for provision of services beyond the call of basic tasks of daily living. Old people and people suffering from terminal illnesses, unless they are at advanced stage of dementia, remain an individual. They have likes and dislikes. They have notions about what gives meaning to their lives. But medicine doesn’t teach such aspects to its acolytes. Atul Gawande makes a strong case for compulsory training in Geriatrics (branch of medicine dealing with the health issues in old) in all medical schools. He says that medicine only talks of life but not of mortality. Medical textbooks do not discuss ageing, frailty or those dying. How it affects people around them? How people experience the end of their lives? Modern medicine has added decades to human life across the globe. But this has also added much burden on the lives of many in their end years. Thus, for many the act of dying has merely been prolonged.

Author says it is important to understand that each individual has different expectations from life as they near their end. Care for old people must include awareness of this need. We must know how people want to spend these years, what kind of trade-offs they are willing to make to achieve these aims and what they consider as absolute necessities of their lives which they cannot barter for some extra time in this world.

He examines various facilities that provide care to an ageing individual; Home care, Nursing homes, Hospice, Assisted-living. Narrating stories of real individuals in these places he discusses merits and drawbacks of each.

Atul Gawande writes with compassion, feeling and intimate understanding of these sensitive issues. His language is easy and his message clear. This book will help many among us to better understand needs of our ageing relatives. I will plead with all doctors to read this book as it will help them align the care they provide to the singular needs of this section of society.