Book Review: Being Mortal by Atul Gawande

Post Author: Rev. Merianna Harrelson

I started Being Mortal: Medicine and What Matters in the End by Atul Gawande two years ago, as the world still reeled from Covid-19. I was preparing for the Lenten season ahead of time. This book I hoped would be the perfect discussion and inspiration after surviving a global pandemic. Then, my father was placed on hospice and I had to put it down. Death again had come to visit my own life, and I couldn’t read about more death. 

This year, I picked Gawande’s book back up and I’m glad I did. Not only does he give an overview and history of the way America approaches end of life care from nursing homes to assisted living, he also interweaves this history with stories of patients and friends who have lived through these changes. For pastors who are ministering to an aging population or ministering to congregational family members who are trying to determine the best fit for aging parents, his insight and reflection will prove invaluable. He manages to weave together his own increasing understanding of the importance of palliative care with a comprehensive understanding of the different options for people as their mobility needs change. For those unfamiliar with the term, the Mayo Clinic defines palliative care as the “specialized medicine that focuses on providing relief from pain and other symptoms of serious illness.” Including palliative care conversations into treatment plan and discussions with patients who are facing life-threatening diagnosis changes the conversation. 

While the history and research behind the approach to an aging population is interesting, I found his insights into the way people’s priorities shift as they confront their own mortality even more engaging. Gawande reflects: “[H]ow we spend our time may depend on how much we perceive ourselves to have.” While it may seem that those who are closer to death are more unfulfilled or depressed, knowing that they are closer to the end of their earthly lives, he notes: “Far from growing unhappier, people reported positive emotions as they aged. They became less prone to anxiety, depression, and anger…[T]hey found living to be a more emotionally satisfying and stable experience.” 

While this may seem counterintuitive, Gawande notes that there is a singularity in focus for people as they near the end of their lives. Rather than seeking out new experiences and new adventures, people instead tend to narrow their focus to spending time with people they love. “They focus on being rather than doing and on the present more than the future.” For anyone who practices meditation or mindfulness, this is the very aim of these practices: to come back to the present, to still body and mind, and be here now. Isn’t it interesting that as people are confronted with the end of life, this focus on the now is exactly what they do?

This practice of being in the present isn’t just for those who are aging. Gawande found that the experience wasn’t attached to age, but it came to anyone who was confronted with a terminal diagnosis . When people are reminded that their lives can’t go on forever and that their bodies are indeed mortal, they draw close to those they love, soaking in the ordinary moments of eating together and being with one another to sustain them to the end. 

Indeed, this is the reminder of Lent as well: “You are dust and to dust you shall return.” Remembering our mortality focuses our hearts and minds on what is most important. In Western culture, the tendency is to do more. Gawande admits that medicine has fallen prey to this mentality. “The pressure remains all in one direction, toward doing more,” he reflects. At times this “doing more” can actually prevent patients from living out their days as they really want to. Palliative care on the other hand asks the question, “What does one good day look like?” By narrowing the focus to one day, palliative care practitioners are able to hone in on what matters most to patients such as living without pain, being able to eat chocolate ice cream, being able to be with those I love. 

The addition of palliative care into the medical profession has helped people live to the end of their lives with autonomy. They are able to talk through what they can live with and what they can’t live with to their family members and caregivers. While these conversations are always difficult and uncomfortable, Gawande reflects they have changed the way medicine approaches end of life care for the better. These conversations  put the person who is nearing the end of their life at the helm,deciding how to spend the little time they have left. 

The most poignant part of Gawande’s book is the personal reflection he includes of caring for his aging father. His recounting of his experience as a doctor caring for an aging parent reminds his readers that whether we are the ones who face the end of lives or if we are the ones walking beside a loved one who is facing the end of our lives, the experience of being mortal is one we all must encounter. So the question for all of us is: how do I want to live this one life I have?