Dr. Atul Gawande confronts mortality in the context of modern medicine

By Sophie Newman, Arts and Entertainment Editor     10/22/14 7:54am

In his recent book Being Mortal: Medicine and What Matters in the End, Dr. Atul Gawande confronts an inevitability that the modern world of medicine — and frankly, society — would rather not discuss: death.     

Beginning with an anecdote about the young doctor as a medical school student, naive in the ways in which the difficulties of accepting mortality would affect his career, Gawande describes his experiences with senescence, terminal illnesses and the limits of medicine in preserving life. Gawande’s work is a call to action: He asks not just the medical profession to reconsider its approach to death, but also all of his readers to come to terms with the limits of the human condition. 

Gawande’s accounts of patients aging and the body’s inevitable deterioration are both disturbing and fascinating. In detailed descriptions of tooth decay and brain shrinkage, Gawande gives a straightforward analysis of what happens when a complex system begins to fail. 

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The most heart-wrenching stories in the book, however, are the terminally-ill cases, in which both patients and doctors must navigate the difficult question of how to proceed after diagnosis. From prescription medications to chemotherapy to the latest experimental drugs, there is certainly no shortage of options when it comes to end-of-life care, but treatment can sometimes come at a great cost — namely, quality of life. 

His chief concern becomes the ways in which our system of life-prolonging technology fails to properly confront the issue of mortality and meet the needs of the very people it aims to benefit. One of the reasons for this failure, Gawande notes, is both doctors and patients are reluctant to have harsh, reality-facing conversations. 

In the chapter “Hard Conversations,” Gawande discusses the difficulty in talking about mortality with patients. He describes one particularly moving case in which a 34-year-old female is diagnosed with metastatic lung cancer in her third trimester of pregnancy and his struggle to bring up the issue of death and her goals for the end of life. 

Of course, Gawande notes, there is always the chance of being an exception to the rule. Sometimes, terminally-ill patients live long past what statistics would predict. But, he cautions, basing an entire medical approach on this hope is unfair to the patients and their loved ones and can be incredibly costly. “We have created a multi-trillion-dollar edifice for dispensing the medical equivalent of lottery tickets,” Gawande said.

Gawande’s main concern, then, is that the conversations about end-of-life care tend to involve a risk-benefit analysis and don’t fully consider what the top priorities of the patients are — to not suffer, to not be a burden on their caregivers and to have a sense of completeness with their lives. According to Gawande, this consideration should become part of the responsibility of medical professionals. “We’ve been wrong about what our job is in medicine,” Gawande writes. “We think our job is to ensure health and survival, but really it is larger than that: it is to enable wellbeing, and wellbeing is about the reasons one wishes to be alive.”

But the equation for how to approach death is not universal, nor is it fixed. Determining the limitations of modern medicine’s capabilities is difficult and often painful. In a particularly touching section near the end of the book, Gawande describes his own experience helping his father through the decision to pursue treatment or to let nature take its course. “Helping my father through the struggle to define that moment was simultaneously among the most painful and most privileged experiences of my life,” Gawande writes. 

Being Mortal is honest, thorough and, at times, hard to read — stories of individuals coming to terms with their own and their loved ones’ mortality is heart-wrenching, but Gawande’s clear medical analyses and personal insights make his work both grounded and profound. 

Through anecdote and fact, Gawande dives headfirst into a topic that most are reluctant to bridge and some never willing to confront. His contributions to the conversations about senescence and terminally-ill patients are undoubtedly important, but his most significant insight is in redefining the role that doctors can play in discussing mortality.

“I never expected that among the most meaningful experiences I’d have as a doctor, and really, as a human being, would come from helping others deal with what medicine cannot do, as well as what it can,” Gawande writes. 

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