I first learned about the book Being Mortal when reading the Learnings from Lets talk about death (over dinner). It was mentioned many times in that book and was on the recommendation list of the following reads.

You can think that the book talks about death (and it is true), but for me, it is more about life. Death is unavoidable and talking about it, makes us reflect on what are the more valuable things for us in our lives.

And Being Mortal for me is that. It is a reminder that we have a limited time to live on this earth and it touches on complicated subjects, mainly regarding the last years of our lives and how we can have a better ending to our lives.

Let’s now see more about the book Being Mortal.

This post is part of the series Learnings from books where my goal is to share what I learned from the book that I read. It is a mixture of review and summary with a bit of my opinion and point of view. But, as reviews, these learnings can say more about me than the book itself, so I trust that you the smart reader will take it with a grain of salt.

Learnings from Being Mortal

The book is full of touching stories, it is hard not to get your eyes wet when reading the personal stories there. So, I recommend you read the book. I will not reproduce the stories here as that is not my goal, I will just share what I found were the most important topics and learnings.

I think the message of the book is that we are mortals, and our biology is constrained. And even when medicine has helped us come a long way in extending life, death will come to us at the end, and many other things are important besides only extending life.

medicine’s goal is to extend life

We are living longer and longer. In the past, surviving into old age was uncommon and we have medicine and science to thank for that. But the problem is that medicine’s goal is to fix, to always do something, but sometimes doing nothing is the best thing.

As the author said, “The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins.”

This kind of action bias is not exclusive to the medicine of course, but it affects greatly people that have terminal diseases.

We sometimes discuss hopes instead which is easier than just taking into consideration the reality of the situation. And being able to discuss the real situation, may provide a happier end of life.

what matters to us change

What we spend our time on depends on how much time we perceive to have for ourselves. We are young, we believe we have a lot of time so we prefer to spend more time meeting new people instead of, spending time with a sibling, for example. We also value the more future than the present.

But as we perceive our time coming to a close, we value doing the opposite, we value the present rather than the future and narrow our focus and prefer to spend time with family and close ones.

But interestingly, far from growing unhappier, people reported more positive emotions as they aged. They became less prone to anxiety, depression, and anger. They found living to be a more emotionally satisfying and stable experience as time passed, even as old age narrowed the lives they led.

what is worth living for?

We need to have a reason to live. We tend to assume and wish for safety in our old life, but only safety is not enough, we expect more than safety.

We want to be helpful, play a role, and make our own decisions. Being able to make our decisions and be in control in old age is the goal for most people.

It is not death that the very old tell me they fear. It is what happens short of death-losing their hearing, their memory, their best friends, and their way of life.

Things change when we are very old and not independent anymore, or terminally ill. We have to know our bare minimum. What is the least that we have to have and still be worth living? what makes life worth living when we are old and frail and unable to care for ourselves?

Is just being able to eat ice cream and watch TV a worthwhile life for you? Or just being conscient? Or just even be breathing?

Knowing what is worthwhile life for you will help you make the decision to undergo certain procedures or not, as their side effect can affect what YOU consider essential to be worth living.

everything is trade-offs

When we are terminally I’ll, each procedure has to be thought through with care and weigh the trade-off. Sometimes the best is to do nothing.

As noted in the book, “The fact that we may be shortening or worsening the time we have left hardly seems to register.”, we go from one treatment to another, until the very end.

What we have to do is to question if the treatments have more chance of making our lives worse. Some problems cannot be fixed, so, undergoing certain procedures can make your life worse and even shorter.

As the example in the book: “He chose badly not because of all the dangers but because the operation didn’t stand a chance of giving him what he really wanted: his continence, his strength, the life he had previously known. He was pursuing little more than a fantasy at the risk of a prolonged and terrible death - which was precisely what he got.”

The biggest question is: “What are the trade-offs you are willing to make and not willing to make?”

We should be able to be the writer of our own stories, even when facing the end of life decisions, we need the freedom to shape our lives in ways consistent with our character and wishes.

hospice maybe is a good option

One of the concepts that I didn’t know so well before was hospice. Hospice is a place to live comfortably in the last few days of your life. A place to give people their best possible day, however, they might define it under the circumstance that they are in.

As well stated in the book, “The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in the priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now - by performing surgery, providing chemotherapy, and putting you in intensive care - for the chance of gaining time later. Hospice deploys nurses, doctors, chaplains, and social workers to help people with fatal illnesses have the fullest possible lives right now - much as nursing home reformers deploy staff to help people with severe disabilities.”

letting go

Letting go is the hardest part of mortality. Even people that have a family member in a terminal condition are unprepared for the final stages.

But people with serious illnesses have priorities besides simply prolonging their lives. “Spending one’s final days in an ICU because of terminal illness is for most people a kind of failure. You lie attached to a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said good-bye or ‘It’s okay’ or ‘I’m sorry’ or ‘I love you.’”

That is why important to know what is worth living for, and what trade-offs are you willing to go through are important.

As the book describes: “Our ultimate goal, after all, is not a good death but a good life to the very end. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.”

Favorite quotes

These are my 5 favorite quotes from the book.

  • “Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things.”
  • “The body’s decline creeps like a vine. Day to day, the changes can be imperceptible. You adapt. Then something happens that finally makes it clear that things are no longer the same.”
  • “Discussing a fantasy was easier - less emotional, less explosive, less prone to misunderstanding - than discussing what was happening before my eyes.”
  • “The trouble was that she expected more from life than safety.”
  • “Hope is not a plan, but hope is our plan.”

Other resources

This section is extra and here I compliment the post with content from other sources that resonate with the book.

These are my learnings from the book Being Mortal: Medicine and What Matters in the End, written by Atul Gawande. A special thanks to Vancouver Public Library (VPL) for allowing access to the book for free.

Happy reading!