Being Mortal: Illness, Medicine and What Matters in the End


In the early decades of our life, our focus is on achieving certain goals: primarily goals of a successful career and a happy family. We also believe, that one day we have to give up all this and go for an eternal journey of life-after-death. But what comes in between these two phases never cross us? We somehow forget that life doesn’t end just like that. There is a transition phase; in which we age, become ill and finally fade away. This book, beautifully connects the dots between life and death.

In my life-span, I have only witnessed two deaths personally – my grandfather and my grandmother. My grandfather was a very active and agile man. One night, just like any other night, he slept, but din’t wake up the next morning. That was the end of his story. My grandmother, however, aged, first gracefully and then to the point where she needed assistance to even go to the bathroom. Even though, she had no illness at all, it was debility that took her down. She also passed by in her sleep, very quietly and comfortably. These two close deaths in my life, took my focus away from what comes in between living-life-to-its-fullest and being declared-dead.

Atul Gawande, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and Harvard School of Public Health. His book Being Mortal, is a true eye-opener. It will make you fixate on harsh realities of life. He has used the examples of his patients, friends and family who went through different stages of life-end. You can exercise, eat healthy, take care of yourself all you want, but still, your body will deteriorate as time pass. You become frail, yet you can live independently. You can run your own errands, cook, clean and do all other routine chores, till one day you become so old that it is not possible to live independently any more. So, you are given choices. Choices like living with your children (if they are willing to, that is) or living in a nursing home. Even those living with children, become too difficult to manage and ultimately have to end up in a nursing home. He mentions how nursing homes are nothing but a place of hopelessness for old people. He said in his book:

“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”


In the second part of his book, Atul emphasized on the limitations of medical science and technology. In today’s world, a doctor will always have a lot of choices to offer, treatment after treatment, without little attention to the suffering of the patient. You suffer today to have a better life tomorrow. But that is not always the case. A person’s priorities change when finitude of life strikes them. He gave examples of many terminally ill patients. Treatment for such patients ended up in more misery then recovery. Is ‘Well-being’ of a patient comes under the job description of a doctor?

“Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.” 
This bring us to the question of how much a person wants to live, for some eating chocolate ice-cream and watching a movie, is all that they want from life, but for others reaching to this point, would mean death already. This is where the role of care-givers, and hospice services kicks in. Palliative care is thriving in developed countries. Atul mentions four important questions that should be asked in the end-of-life discussion with any patient:

“What is your understanding of the situation and its potential outcomes?What are your fears and what are your hopes?What are the trade-offs you are willing to make and not willing to make?And what is the course of action that best serves this understanding?”

Finally he narrates the painful experience of the death of his father. His father was an achiever, a brave man who fought through thick and thins of life and finally established himself as a respected urologist in America. He was hit by tumour in his spinal cord, which gradually moved from the back of his neck to his brain. He avoided surgery till the very end, lest it leaves him quadriplegic. Eventually when he got the surgery done it was of no use and the tumour grew as opposed to getting shrunk. That was when he opted for hospice service and eventually gave up on life at the warm comfort of his bed. It’s best to let go at times and not fight with fate any more.

Despite being a doctor himself, Atul has not use much medical jargon, and hence it was easy to comprehend for a layman like me. I cannot recommend this book more. It has moved me, and it is sure to remain with me for a long time.






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