What matters in the end

This is my review of Being Mortal, by Atul Gawande.

I have been lucky enough to know my grandparents, and other relatives of their generation. Like most other Indian kids, a sense of respect for the elderly was drilled into my head at a young age. Culture aside, I relied on my grandparents to be more laid back and indulgent than my parents were.

It’s painful, even as a child, to watch someone you love gradually lose their health and dignity to old age. In many cases, this is accompanied by a not insignificant amount of physical suffering. Incontinence, dementia, poor immunity, weakening of bones- the list is endless. I discovered this book on Goodreads, and made a spur of the moment trip to Blossoms to pick it up when a close relative was diagnosed with an untreatable cancer.

Atul Gawande is an Indian origin medical doctor and writer in the USA. I’ve read only one of his other books, Complications. He tries to bring a touch of humanity to medicine, a science that is rapidly becoming about business and profit. When a senior citizen is diagnosed with a terminal illness- usually cancer- the knee-jerk reaction is to fight it head on with poisonous chemotherapy and radiation therapy. Gawande urges doctors to think twice before prescribing painful treatments that are unlikely to work. The role of a doctor, he says, is to improve the quality of life and not merely its quantity.

He substantiates his suggestions with statistics. Apparently, a huge chunk of medical spending in the US can be attributed to people in the last year of their lives. When the treatments aren’t working, Gawande argues, why put patients through painful surgeries and hospital stays? He also puts forth a framework for deciding on treatment paths, especially in the case when the medical decision making falls to a relative of the patient. What does the patient value most in his/her life? Is it physical mobility? Being able to spend time with relatives? Or is it the ability to live independently? Based on the answer to these questions, sometimes it is more appropriate to send a patient to hospice care, or prescribe palliative surgery instead of aggressive treatment.

I give this book a 4/5, because I could relate very well to the issues discussed. Gawande discusses an emotionally charged subject with the right balance of head and heart. I very much hope that you don’t like this book, because that means that you have likely never seen a loved one suffer.

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