Being Mortal (Atul Gawande)
Being Mortal is the first in a stack of ~50 books I wanted to read on the subject of mortality. This list will probably grow indefinitely, but 50 is a good place to start. I don’t intend any of these “reviews” to be in depth summaries, because there are other sites for that. Instead, I want to pull out all the secular bits that resonate with me as someone who will eventually die. I also want to identify how this information can be turned into meaningful action.
OVERVIEW
The overarching theme of Being Mortal is that modern medicine has turned aging and dying into strictly medical events, and that this transformation has been to our detriment. Based on the book, I believe the main consequences are:
· the persistent inability of physicians and their terminally ill patients to have difficult but necessary conversations (e.g. what is most important to you in the end, what tradeoffs would you and wouldn’t you make for more time)
· with medicine allowing us to live longer, healthier, more productive lives, we regard our inevitable infirmity or frailty as weakness – something abnormal, something to be embarrassed of
· elder care facilities set medical goals related to safety and survival, but not often personal goals (humans crave liberty, freedom, and authorship; even when frail, even when dependent, even when dying)
· a lack of imagination and curiosity for defining what a good ending might look like
I won’t go into detail, but Gawande also dispels any wistful notions we may have about our children living with and taking care of us. Studies show that where financially possible, both children and their parents prefer to be independent and to live separately, what social scientists call “intimacy at a distance.” We have replaced the veneration of elders not with the veneration of youth, but with veneration of the independent self.
Gawande reflects: “Our reverence for independence takes no account of the reality of what happens in life: sooner or later, independence will become impossible. Serious illness or infirmity will strike. It is as inevitable as sunset. And then a new question arises: If independence is what we live for, what do we do when it can no longer be sustained?” His book draws on experiences from those with terminal illness, and those who are aging.
WHAT NOW? (actions for mortal atheists)
Overviews are nice, but how do we turn golden nuggets from these books into actions? Extrapolating from Being Mortal, here are my thoughts:
Research the aging process
Get familiar with what’s going to happen to your body as you age. Crumbling teeth, a brittle skeleton, papery skin, crunchy arteries, muscle weakness, etc. (pages 29-31 will give you a great sampling). Don’t focus on miracles of biology (e.g. the 100 year old who runs a marathon) as the norm – that might get in the way of you thinking meaningfully and realistically about aging well until it’s too late.
Reflect on independence and meaning – all the time
Prepare to constantly redefine independence, purpose, and a meaningful existence. Age or terminal illness are likely to narrow our independence, and with that, our interpretation of purpose or meaning may have to narrow as well.
Change your perspective
Dr. Laura Carstensen says that as we age our perspective changes. We become less focused on new experiences, new people, or pursuing achievement, and turn instead toward established friends and family, towards everyday pleasures and relationships. We focus on being rather than doing. We focus on the present rather than the future. Because people facing terminal illness do the same, she hypothesizes that it’s not aging that changes your perspective, but “your personal sense of how finite your time in this world is.” The action for us seems twofold: 1) nurture close personal relationships and focus on being present, and 2) meditate on your own impermanence. Both actions are mutually supportive.
Carstensen’s hypothesis was that “how we seek to spend our time may depend on how much time we perceive ourselves to have.” If you want to learn more, she called this hypothesis socioemotional selectivity theory.
Find out what people want near the end – it will probably be what you want
Called out in the book are avoiding suffering, being mentally aware, spending time with loved ones, feeling like your space is your home, and having autonomy to be the author of your own story. Equally important is avoiding boredom, loneliness, and the feeling of helplessness. Drawing on the collective experiences of others, we can glean what might be important to us too.
Research your options
As an extension of the above, people nearing the end of their lives want facilities that provide them with friendship, privacy, and purpose. It’s clear from this book that excellent assisted living facilities and elder care philosophies do exist. The Eden Alternative, Green House Project, and others are proof. With this in mind, research the assisted living facilities in your area. Research hospice and palliative care. Know what’s important to you before it’s chosen for you. (Bonus: a compelling case is made that having pets, plants, and children around are game changers).
Know what questions to ask yourself when time is short
One thing made crystal clear in this book is most Doctors (like us) can be uncomfortable accepting that nothing else, realistically, can be done. We’d all much rather sell ourselves a fantasy. Treatments or interventions with increasingly smaller chances of success may make collateral of the quality time you have left. Research what questions to ask yourself, and your Doctor. Questions like:
· What tradeoffs are you willing to make and not willing to make?
· What would you sacrifice now for more time later?
· What would be most important to you if your health worsened?
IN SUM
Is this book entirely secular? Yes.
If you had to describe the book in one sentence? We want authorship of our lives right until the end, and most mainstream nursing homes sound awful.
Who should read this book? People who want to confirm for themselves that freedom and autonomy can exist along the entire spectrum of infirmity and dependence.
Who shouldn’t read this book? People who already had a phobia of nursing homes.