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

Being Mortal, Atul Gawande's New York Times best seller, was published in 2014. Gawande, an American surgeon and public health researcher, has written a series of articles, essays, and books that probe the US health care industry. His first book, Complications: A Surgeon's Notes on an Imperfect Science, was a finalist for the National Book Award, and he followed it in 2007 with Better: A Surgeon's Notes on Performance. Throughout his work, Gawande offers his practical, real-life experience as a surgeon to make the field more accessible to laypeople.

In Being Mortal, Gawande is on a quest to determine what truly compassionate end-of-life care looks like and how it can be possible in the era of modern medicine. The writer acknowledges the breakthroughs that make previously life-threatening illnesses manageable and childbirth safer, but points out that human mortality is still an essential fact of life. Modern medicine is focused on combatting death, 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 frankly and realistically. Gawande’s vision for end-of-life care pushes back against efforts to prolong life by any means possible, making a compelling case that his is the better way to live and to die.

The author reflects on what went right and wrong in the deaths of his grandfather and father. While he feels that both died with dignity, he acknowledges that the way his grandfather passed away in India—at home, surrounded by relatives who did not curtail his activities or appetite—would never happen in a first-world nation. Instead, his grandfather would have been placed in a nursing home and deprived of the things that gave his life meaning, in the name of prolonging his life.

In his father's case, Gawande appreciates the difficult decision to not fight death by any means possible. He describes his worry when his father, an American physician, opts to not undergo a major invasive surgery that might give him more time. Instead, his father remains as active as possible and just before he passes, is medicated just enough to be at peace and to tell his family how he wishes to have his ashes dispersed.

Gawande also explores the experiences of his patients in his theory of a good death. 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 describes the harrowing final moments of those who endured risky and ultimately futile procedures to gain just a little more time. From these experiences, Gawande learns a new way to talk about death with his patients.

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