In his fourth book, Being Mortal: Medicine and What Matters in the End, Dr. Atul Gawande, MD, has ambitiously crafted a historical and narrative account of aging, long-term care, assisted living, and hospice in America.
Dr. Gawande covers a broad range of fundamental social issues. These discussions range from the implications of longer lives and increased mobility of adult children, to real narratives demonstrating the major decisions that individuals have to make near the end of life involving personal safety, personal choice, and quality of life versus quantity.
One interesting section follows a physician geriatrician who, despite his lifetime of experience treating the elderly, eventually succumbed to physical and cognitive deterioration himself. What is fascinating about this section is that the geriatric geriatrician is actively aware and accepting of his functional losses as they happen. In one instance, even this trained expert realizes he cannot prevent himself from choking on his own food.
One classic story describes the experimental pilot program created by Dr. Bill Thomas, MD, at the Chase Memorial Nursing Home in New York which introduced one hundred parakeets, four dogs, two cats, rabbits, and a flock hens into the nursing facility. The retelling of the initial discussions between Dr. Thomas and the facility’s administration and nursing staff are hilarious. Now the landmark experiment, which required several waivers from New York’s state facility codes, shows that the interventions correlated with a decrease in facility drug costs to only 38% of the costs incurred by comparable facilities. Deaths fell 15%.
Beyond nursing homes, Dr. Gawande reminds us that the entire assisted living industry is relatively new as he recounts the struggles of Keren Brown Wilson, Ph.D. in the 1980s against Oregon’s regulatory requirements to establish a facility where residents could simply lock their own doors from the inside. Dr. Brown impressively raised millions of dollars of investment to develop and construct the first assisted living community, which then exploded into a giant industry.
Finally, Dr. Gawande introduces us to hospice care with a narrative account of his own father’s last fight against brain cancer. Even Dr. Gawande, a surgeon, and his two parents, both physicians, struggle to make what they believe are the best decisions during the last years of his father’s life. However, even they could not always anticipate how ineffective and physically taxing some treatments would prove. This discussion of the trade-off between the quality of time and the quantity of time is a core theme throughout the book.
Being Mortal: Medicine and What Matters in the End is available for purchase from all major book retailers.