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Being Mortal: Medicine and What Matters in the End

by Atul Gawande

This book was a helpful companion in dealing with the grief after my dad passed away.

Here are some of my takeaways and favorite quotes:
  • "The pattern of decline had changed, however, for many chronic conditions. Instead of delaying the moment of the downward drop, our treatments can stretch the descent out until it ends up looking less like a cliff and more like a hilly road down the mountain."
  • What assisted living looks like: "The services were, in most ways, identical to the services that nursing homes provide. But here the care providers understood they were entering someone else's home, and that changed the power relations fundamentally. The residents had control over the schedule, the ground rules, the risks they did and didn't want to take.... The goal was that no one ever had to feel institutionalized."
  • Socioemotional selectivity theory:  When horizons are expansive, and measured in decades, you desire all the stuff at the top of the Maslow hierarchy - achievement, creativity, and other attributes of self-actualization. When horizons contract (such as end of life or uncertain times like a pandemic), your focus shifts to the here and now, to everyday pleasures and the people closest to you.
  • "We want autonomy for ourselves and safety for those we love. Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe on our sense of self."
  • Through hospice and palliative care, "we witnessed for ourselves the consequences of living for the best possible day today instead of sacrificing time now for time later."
  • At the root of the euthanasia debate "is about what mistakes we fear most - the mistake of prolonging suffering or the mistake of shortening valued life."
  • "Technological society has forgotten what scholars call the "dying role" and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those left behind will be okay. They want to end their stories on their own terms."
  • "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, of when debility comes, but all along the way."
  • Four questions:
    • What is your understanding of the situation and its potential outcomes?
    • What are your fears? What are your hopes?
    • What are the trade-offs you are willing to make and not willing to make?
    • What is the course of action that best serves this understanding?
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