I felt very much alive reading Dr. Atul Gawande’s new book, Being Mortal. Not because I have a sense of youthful immortality, but because stuck here in the sandwich generation I’m feeling a bit caught in-between — feeling simultaneously mortal and then very alive. In my mind this has a little bit to do with turning 40, a bit to do with the gift of raising young children, and a whole lot more to do with a year of losing people I love. Over the last 11 months I feel like my soul has aged by a decade as people I’ve loved and held onto have passed away. When dealing with death some hours can feel far more centurion than any others we can remember.
Gawande’s words granted some space to reflect on both my profession and my role as a parent, wife, daughter, sister, relative and friend. There’s a balanced vulnerability woven throughout the book that facilitates our joining into his stories as peers. And although the book begins notably academic, it accelerates into a rich narrative of love, endurance, small failures and singular courage. In its essence, Being Mortal is about one man’s journey loving his family, caring for patients, discovering inadequacies in his profession and interrogating the options afforded us all in living our lives with intention.
As a true “middle-ager,” sitting with these words felt to me a bit like peering over a vast, newly frozen Great Lake. Imagine letting your eyes move from left to right, looking out at the cracks in the ice and swirling snow as you capture the enormity of the expanse and what lies in front of you. But remember that this Great Lake is enormous, as big as the potential space of the lives in front of us. The words in Being Mortal can feel like a nudge. It’s as if while looking out from the shores of that frozen lake you hear someone whisper, “ Why, yes, it’s only been frozen overnight, but please just get up and run across it, Girl.” And you will, never knowing just when you’ll fall in.
Illness is treacherous and death inevitable for us all of course. Yet Gawande reminds us that with careful intention we can shift our fate:
“The goal is not a good death,” he says, “ the goal is to have as good a life as possible until the very end.”
Monday evening I heard Dr. Atul Gawande speak in Seattle. He told a few stories from the book and reconciled inconsistencies with the practice of medicine and what matters in the end of our lives. And although his talk was good, the Q&A after was better. Probing questions about the way to live is where Gawande’s intelligence, gentleness, wit and sincerity come alive. When a woman asked Gawande his take on Dr. Ezekiel Emmanuel’s recent provocative piece in The Atlantic claiming he’ll avoid living a day past 75 years, Dr. Gawande replied, “he’s [Dr. Emmanuel] missing out on a frame of perception…my book is hopefully an argument for a more imaginative view” on life and death.
For me this book was both academic and personal. As a practicing doctor and previous student of bioethics, I enjoyed the delve into the quandary of where and when medicine has a place in our lives and what limits doctoring and intervention is afforded as we run out of choices. Not surprisingly, I enjoyed reading about Dr Gawande’s experience with his own life, his love for family and his own challenges in losing his father the most.
My world is slowing down again these days as I lose my beloved mother-in-law. It’s perhaps why Gawande’s thoughts lit a fire in me. The centurion moments have resurfaced as our family cares for her at the end of her life. My middle of the night wake-ups have begun again and the quest to understand how to lose and let go are resurfacing. But I cannot stress enough how much this book helped my aching.
If you have little time, read the introduction, the last two chapters (Hard Conversations and Courage) but do your best to stop in on page 74, “trouble was she expected more from life than safety,” and “I was confusing care with treatment” on page 112. Oh, and wait: please don’t miss the delicious riff on the challenges that culture presents to innovation on page 120 where Gawande had me leaning forward in my seat as he detailed how Dr. Bill Thomas, a family physician, figured out how to bring alive a nursing home while importing hundreds of parakeets.
If you can, carve out time to read the whole book and live out Gawande’s own truth (page 239) where he says, “In stories, endings matter.” Yes they do, in Being Mortal and beyond. Thanks, Dr. Gawande.