The prescription, he argues in “Being Mortal,” is to rethink our priorities for the dying—and give ’em something to live for.
In Being Mortal, Gawande, a longtime staff writer for the New Yorker, takes on the utter failure of the medical profession when it comes to helping people die well, and the short-sightedness of the elder facilities that infantilize people rather than bother to figure out what they actually need to maintain a modicum of meaning in what’s left of their lives. In the process, he gives us a lesson on the basic physiology of aging and on the social and technological changes that led to most of us dying in hospitals and institutions rather than at home with our loved ones. And he chronicles the rise of the nursing home and the creation of assisted living as its antidote—if only it were.
The picture can seem pretty bleak. Many of Gawande’s subjects are dealing with the always-hopeful oncologists who, rather than accept the inevitable, coax their patients into trying futile fourth-line chemotherapies that nobody can pronounce. And then you’ve got hospitals axing their geriatrics departments (aging Boomers be damned) because Medicare won’t cover the extra costs of making someone’s last years worth living. There’s also a deeply personal aspect to the book, which goes on sale today. Gawande recounts the recent travails of his family, which began when his father, also a surgeon, was diagnosed with a cancer that would slowly eat away at his physical capabilities and ultimately end his life.
But Being Mortal is hopeful, too, and that’s why it could make a difference. Most of the changes we need to make aren’t expensive. Indeed, some of them could save us a bundle in cash and needless suffering. It turns out, for example, that terminal patients in hospice programs often live longer and better than their counterparts in treatment. In fact, the mere act of talking with caregivers about what you value as you near the end of your life leads to a longer one. Gawande also introduces us to quirky visionaries who took it upon themselves to improve matters. My favorite was Bill Thomas, a young doctor who somehow convinced state regulators to let him turn a nursing home into a menagerie. “I mean, he was a crazy-man!” Gawande told me with a laugh when I called to grill him on the details. But sometimes that’s what it takes to wake people up.
Mother Jones: In the book, you write about how, hundreds of years ago, there used to be these very popular guidebooks instructing people on how to die well. Have we, as a society, forgotten how to do that?