Being Mortal (Gawande)

Being Mortal: Medicine and What Matters in the End
Atul Gawande, 2014
Henry Holt & Co.
304 pp.
ISBN-13: 9781250081247


Summary
Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending.

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit.

Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end. (From the publisher.)

Author Bio
• Birth—November 5, 1965
• Where—Brooklyn, New York City, New York, USA
• Rasied—Athens, Ohio
• Education—B.S., Stanford University ; M.A. Oxford Universty; M.D., M.P.H., Harvard University
• Awards—(see below)
• Currently—lives in Newton, Massachusetts


Atul Gawande is an American surgeon, author, and public health researcher. He is a general and endocrine surgeon at Brigham and Women’s Hospital, professor in both the Department of Health Policy and Management at the Harvard School of Public Health and the Department of Surgery at Harvard Medical School. In his work in public health, he is Executive Director of Ariadne Labs, a joint center for health systems innovation and also chairman of Lifebox, a nonprofit reducing deaths in surgery globally.

Early years
Gawande was born in Brooklyn, New York to Indian Maharashtrian immigrants to the United States, both doctors. The family soon moved to Athens, Ohio, where he and his sister grew up. He obtained an undergraduate degree from Stanford University in 1987. He was a Rhodes scholar, earning a degree in Philosophy, Politics & Economics from Balliol College, Oxford in 1989. Gawande graduated from Harvard Medical School in 1995. He also has a Master of Public Health degree from the Harvard School of Public Health, earned in 1999.

Political career and medical school
As a student, Gawande was a volunteer for Gary Hart's campaign. As a Rhodes Scholar, he spent one year at Oxford University. After graduation, he joined Al Gore's 1988 presidential campaign. He worked as a health-care researcher for Rep. Jim Cooper (D-TN), who was author of a "managed competition" health care proposal for the Conservative Democratic Forum. After two years he left medical school to become Bill Clinton's health care lieutenant during the 1992 campaign and became a senior adviser in the Department of Health and Human Services after Clinton's inauguration. He directed one of the three committees of the Clinton Health Care Task Force, supervising 75 people and defined the benefits packages for Americans and subsidies and requirements for employers.

He returned to medical school in 1993 and earned a medical degree in 1994.

Journalism
Soon after he began his residency, his friend Jacob Weisberg, editor of Slate, asked him to contribute to the online magazine. His pieces on the life of a surgical resident caught the eye of The New Yorker which published several pieces by him before making him a staff writer in 1998.

A June 2009 New Yorker essay by Gawande compared the health care of two towns in Texas to show why health care was more expensive in one town compared to the other. Using the town of McAllen, Texas, as an example, it argued that a revenue-maximizing businessman-like culture (which can provide substantial amounts of unnecessary care) was an important factor in driving up costs, unlike a culture of low-cost high-quality care as provided by the Mayo Clinic and other efficient health systems.

Ezra Klein of the Washington Post called it "the best article you'll see this year on American health care—why it's so expensive, why it's so poor, [and] what can be done." The article was cited by President Barack Obama during Obama's attempt to get health care reform legislation passed by the United States Congress. The article, according to Senator Ron Wyden, "affected [Obama's] thinking dramatically" and who later said to a group of Senators, "This is what we’ve got to fix." After reading the New Yorker article, Warren Buffett's long-time business partner Charlie Munger mailed a check to Gawande in the amount of $20,000 as a thank you to Dr. Gawande for providing something so socially useful. Gawande donated the money to the Brigham and Women's Hospital Center for Surgery and Public Health.

In addition to his popular writing, Gawande has published studies on topics including military surgery techniques and error in medicine, included in the New England Journal of Medicine. He is also the director of the World Health Organization's Global Patient Safety Challenge. His essays have appeared in The Best American Essays 2003, The Best American Science Writing 2002, and The Best American Science Writing 2009.

Books
In 2002 Gawande published his first book, Complications: A Surgeon's Notes on an Imperfect Science. It was a National Book Award finalist and has been published in over one hundred countries.

His second book, Better: A Surgeon's Notes on Performance, was released in 2007. It discusses three virtues that Gawande considers to be most important for success in medicine: diligence, doing right, and ingenuity. Gawande offers examples in the book of people who have embodied these virtues. The book strives to present multiple sides of contentious medical issues, such as malpractice law in the US, physicians' role in capital punishment, and treatment variation between hospitals.

Gawande's third book, The Checklist Manifesto: How to Get Things Right, came out in 2009. It discusses the importance of organization and pre-planning (such as thorough checklists) in both medicine and the larger world. The Checklist Manifesto reached the New York Times Hardcover nonfiction bestseller list in 2010.

Being Mortal: Medicine and What Matters in the End was in October 2014.

Awards and recognition
In 2006, Gawande was named a MacArthur Fellow for his work investigating and articulating modern surgical practices and medical ethics. In 2007, he became director of the World Health Organization's effort to reduce surgical deaths, and in 2009 he was elected a Hastings Center Fellow.

In 2004, he was named one of the 20 Most Influential South Asians by Newsweek. In the 2010 Time 100, he was included (fifth place) in Thinkers Category. Also in 2010, he was named by Foreign Policy magazine to its list of top global thinkers.

Personal life
Gawande lives in Newton, Massachusetts with his wife, Kathleen Hobson, who is a Stanford graduate, and their three children: Walker, Hattie, and Hunter. He enjoys reading. (From Wikipedia. Retrieved 10/12/2014.)

Book Reviews
"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. Being Mortal uses a clear, illuminating style to describe the medical facts and cases that have brought him to that understanding.
Janet Maslin - New York Times


Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is "to enable well-being." If that sounds vague, Gawande has plenty of engaging and nuanced stories to leave the reader with a good sense of what he means…Being Mortal is a valuable contribution to the growing literature on aging, death and dying. It contains unsparing descriptions of bodily aging and the way it often takes us by surprise. Gawande is a gifted storyteller, and there are some stirring, even tear-inducing passages here. The writing can be evocative…. The stories give a dignified voice to older people in the process of losing their independence. We see the world from their perspective, not just those of their physicians and worried family members.
Sheri Fink - New York Time Book Review


Dr. Gawande’s book is not of the kind that some doctors write, reminding us how grim the fact of death can be. Rather, he shows how patients in the terminal phase of their illness can maintain important qualities of life (Best Books of 2014).
Wall Street Journal


Atul Gawande’s wise and courageous book raises the questions that none of us wants to think about.... Remarkable.
John Carey - Sunday Times (UK)


Gawande’s book is so impressive that one can believe that it may well [change the medical profession].... May it be widely read and inwardly　digested.
Diana Athill - Financial Times (UK)


Being Mortal, Atul Gawande’s masterful exploration of aging, death, and the medical profession’s mishandling of both, is his best and most personal book yet.
Boston Globe


Masterful.... Essential.... For more than a decade, Atul Gawande has explored the fault lines of medicine...combining his years of experience as a surgeon with his gift for fluid, seemingly effortless storytelling.... In Being Mortal, he turns his attention to his most important subject yet.
Chicago Tribune


A needed call to action, a cautionary tale of what can go wrong, and often does, when a society fails to engage in a sustained discussion about aging and dying.
San Francisco Chronicle


Beautifully crafted.... Being Mortal　is a clear-eyed, informative exploration of what growing old means in the 21st　century...a book I cannot recommend highly enough. This should be mandatory reading for every American.... [I]t provides a useful roadmap of what we can and should be doing to make the last years of life meaningful.
Time.com


Beautifully written.... In his newest and best book, Gawande...has provided us with a moving and clear-eyed look at aging and death in our society, and at the harms we do in turning it into a medical problem, rather than a human one.
New York Review of Books


Being Mortal left me tearful, angry, and unable to stop talking about it for a week.... A surgeon himself, Gawande is eloquent about the inadequacy of medical school in preparing doctors to confront the subject of death with their patients.... it is rare to read a book that sparks with so much hard thinking.
Nature

　
Eloquent, moving (Best Books of 2014).
Economist


A great read that leaves you better equipped to face the future, and without making you feel like you just took your medicine (Best Books of 2014).
Mother Jones

Leading surgeon, Harvard medical professor, and best-selling author, Gawande is also a staff writer at The New Yorker, which published the National Magazine Award-winning article that serves as the basis for this study of how contemporary medicine can do a better, more humane job of managing death and dying.
Library Journal


Gawande displays the precision of his surgical craft and the compassion of a humanist...in a narrative that often attains the force and beauty of a novel.... Only a precious few books have the power to open our eyes while they move us to tears. Atul Gawande has produced such a work. One hopes it is the spark that ignites some revolutionary changes in a field of medicine that ultimately touches each of us (Best Books of 2014).
Shelf Awareness


[A] cleareyed look at aging and death in 21st-century America.... Gawande offers a timely account of how modern Americans cope with decline and mortality. He points out that dying in America is a lonely, complex business.... A sensitive, intelligent and heartfelt examination of the processes of aging and dying.
Kirkus Reviews

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