Last Saturday I spent the afternoon reading Atul Gawande‘s Being Mortal: Medicine and What Matters in the End. I have long admired Dr. Gawande’s writings, and turn to him as one of my go-to thought leaders in medicine. If you’re not familiar with Dr. Gawande, he is a surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women’s Hospital in Boston. He is Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School. Dr. Gawande has been a staff writer for The New Yorker magazine since 1998 and has written four New York Times bestsellers: Complications, Better, The Checklist Manifesto, and now, Being Mortal. Here’s a link to one of his Ted Talks: How Do We Heal Medicine?
Being Mortal, the text, is about the need to do more within the field of medicine to address the “well-being” of patients – shifting from a maniacal focus on fixing, repairing and survival. According to Dr. Gawande, “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way.” (Being Mortal, P. 259)
“The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want a Custer. You want a Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.” (Being Mortal, p. 187.)
So what brand of physician do you want when you face the end: A Custer or a Robert E. Lee? It is an important consideration – even if we don’t like thinking about it. What does matter most in the end?
Throughout this text, Gawande kept me captivated with a series of well told stories, including that of his father’s decline and eventual death. This is an exceptional text. I was reminded of Dr. McCullough’s text, My Mother, Your Mother: Embracing Slow Medicine, The Compassionate Approach to Caring for your Aging Loved Ones.
It must be my age, and the age of my parents, but I’ve been doing a lot of reading about the way we care for the elderly and for those with terminal illnesses. Some of my favorites, beyond Dennis McCullough’s text, include: