Atul Gawande wrote a book that changed my life- The Checklist Manifesto – it changed how I work and approach many (complex) things. I wish a lot of project managers I know would read it. So when I found out he wrote a book that addressed end of life issues, I had to read it. It did not disappoint. Was it as good as The Checklist Manifesto? No, but it's still good. 7½ stars, rounding down to 7. ★★★★★★★
Gawande organizes it in 8 chapters – the Independent Self, Things Fall Apart, Dependence, Assistance, A Better Life, Letting Go, Hard Conversations and Courage, with an epilog. And yes, it does have citations of a lot of reference materials. He wouldn't be a surgeon or physician without them. But, this is also a very personal book for Gawande. It talks about his grandmother-in-law's decline and death, about his patients, friends, his grandfather and father. And their deaths. So, yeah, it isn't light reading.
I particularly wanted to know how Dr. Gawande wanted to address the medicalization of death, especially since he's a surgeon – folks who routinely make heroic, lifesaving interventions. He didn't disappoint because he addressed it directly by looking at the history, how things have changed and by also admitting his own role in that process. Then by changing. I admire that he did that. So, on to the book.
He writes about how we medicalized death over the 20th century, how nursing homes came into being and used the asylum and hospital models. Things which strip away independence and dignity for convenience of managing the patient, er, resident.
He also writes about how all the heroic medical interventions at the last stages of life for old age make it so much worse, spending huge amounts of money for relatively little time and time of such poor quality. Also, these interventions can shorten life, as well as make it a misery. He gives examples of how these deaths happen and brings the receipts as well.
Being Mortal is a thought provoking book, but Gawande stops short. He shows us medicalized death is bad, with examples, but doesn't get into how to have a good death. He doesn't go into specifics, which is what we need. Fortunately, there is The Good Death by Suzanne B. O'Brien which does get into those details.
Did this have the same impact on me as the Checklist Manifesto? No. But it does start a conversation we need to have about death and how we will experience it.
Also, seeing some of Gawande's personal experiences with death as doctor, family member, friend, student of death and, ultimately, a son are moving and lend immediacy to the book. Still, by failing to prescribe how to have a good death, Gawande stops short of where he needs to go.
7½ stars, rounding down to 7. ★★★★★★★
by BravoLimaPoppa