Just a few generations ago, our unshielded ancestors were faced with mortality on a regular basis. A proportion succumbed at birth, and whoever made it through had a good chance that childhood, motherhood, or a plethora of other ordeals would mark their early demise. The living were intimately acquainted with death and the dying process; indeed my grandmother describes viewing the body of a dead relative at the tender age of seven. ‘Being mortal’ is synonymous with being human, and yet most of us are notoriously bad at planning for the inevitable.
In this profoundly moving book, Atul Gawande recounts his professional and personal encounters with age, death, and dying, from the young woman with cancer who is subjected to endless debilitating treatment in a futile pursuit for survival, to the experiences of his own family navigating his father’s final years. This is a candid read, and an admirable account of Gawande’s own philosophy, never shying away from the times he may have been mistaken.
As doctors it can be difficult to embrace death when we seek so often to defy it, but medical care in the dying period can be as essential for patients as any other kind of treatment. The story of one of Gawande’s patients, a lady whose last weeks were made bearable by surgery to unblock her strangled bowel, is such an example — the operation proved to be just as life changing as any curative procedure.
In a provoking deconstruction of the options open to us in our final few years, Gawande uses the stories of individuals to highlight the inadequacy of our current solutions; the retirement homes and hospices that dominate our perception of end-of-life care.
Such places, he argues, should be filled with additional life, citing the bedbound resident who began to speak when a pair of parakeets moved into his room, and the apartment block owner who made heroic efforts to house her elderly tenants so that they could continue to enjoy a margarita in their own living room. The message could perhaps be summarised as: the process of dying involves living, and every effort is required to ensure we do it justice.