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

Surgeon and author Atul Gawande is on a quest to determine what truly compassionate end-of-life care looks like and how to make that possible in an era of modern medicine. The writer acknowledges all the astounding breakthroughs that have made previously life-threatening illnesses manageable and childbirth safer. Infant mortality is down, clearly a gain, but human mortality is still an essential fact of life. Combatting death has been the business of modern medicine, Gawande asserts, so what does that mean for patients when death is imminent? Drawing on both professional and personal experiences, Gawande attempts to map out a way for individuals to face death in a frank and realistic way. Gawande’s vision for end-of-life care runs counter to contemporary efforts to prolong life by any means possible. But Gawande makes a compelling case that his is the better way to live and to die.

The author reflects on the deaths of his own grandfather and father and maps out what went right and wrong in those processes. Both died with dignity, he feels, but he acknowledges that in modern, first-world nations, the way in which his grandfather passed away in India—at home, surrounded by relatives who did not curtail his activities or appetite—would never happen. Instead, his grandfather would be placed in a nursing home, where he would have been deprived of all the things that gave his life meaning, all in the name of prolonging his life.

Assessing the passing of his American physician father, Gawande appreciates his father’s difficult decision to not fight death by any means possible. The author describes his worry as a loving son when his father opts to not undergomajor invasive surgery that might give him more time. His father instead remains as active as possible nearly up until the end, and just before he passes, Gawande’s father is medicated just enough to be at peace and to dictate to his family how he wishes to have his ashes dispersed.

The experiences of patients figure into Gawande’s equation for a good death, too. He notes the instances in which an acceptance of mortality helped patients truly have quality time at the end. As a point of contrast, he also describes the harrowing final moments of those who endured risky and ultimately futile procedures in order to gain just a little more time. From these experiences, Gawande learns a new style of talking about death with his patients.

Finally, Gawande also reflects on the lessons offered by Tolstoy’s “Death of Ivan Ilyich.” The titular character’s quest for companionship and recognition of his full humanity just before he passes inspires Gawande to advocate for the same for contemporary patients.