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Being Mortal Paperback – September 5, 2017

4.7 4.7 out of 5 stars 47,514 ratings

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Named a Best Book of the Year by The Washington Post, The New York Times Book Review, NPR, and Chicago Tribune, now in paperback with a new reading group guide

Medicine has triumphed in modern times, transforming the dangers of childbirth, injury, and disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should.

Through eye-opening research and gripping stories of his own patients and family, Gawande reveals the suffering this dynamic has produced. Nursing homes, devoted above all to safety, battle with residents over the food they are allowed to eat and the choices they are allowed to make. Doctors, uncomfortable discussing patients' anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them.

In his bestselling books, Atul Gawande, a practicing surgeon, has fearlessly revealed the struggles of his profession. Here he examines its ultimate limitations and failures―in his own practices as well as others'―as life draws to a close. Riveting, honest, and humane,
Being Mortal shows how the ultimate goal is not a good death but a good life―all the way to the very end.

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Editorial Reviews

Review

“Wise and deeply moving.” ―Oliver Sacks

“Illuminating.” ―
Janet Maslin, The New York Times

“Beautifully written . . . In his newest and best book, Gawande has provided us with a moving and clear-eyed look at aging and death in our society, and at the harms we do in turning it into a medical problem, rather than a human one.” ―
The New York Review of Books

“Gawande's book is so impressive that one can believe that it may well [change the medical profession] . . . May it be widely read and inwardly digested.” ―
Diana Athill, Financial Times (UK)

Being Mortal, Atul Gawande's masterful exploration of aging, death, and the medical profession's mishandling of both, is his best and most personal book yet.” ―Boston Globe

“American medicine,
Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande's most powerful--and moving--book.” ―Malcolm Gladwell

“Beautifully crafted . . .
Being Mortal is a clear-eyed, informative exploration of what growing old means in the 21st century . . . a book I cannot recommend highly enough. This should be mandatory reading for every American. . . . it provides a useful roadmap of what we can and should be doing to make the last years of life meaningful.” ―Time.com

“Masterful . . . Essential . . . For more than a decade, Atul Gawande has explored the fault lines of medicine . . . combining his years of experience as a surgeon with his gift for fluid, seemingly effortless storytelling . . . In
Being Mortal, he turns his attention to his most important subject yet.” ―Chicago Tribune

“Powerful.” ―
New York Magazine

“Atul Gawande's wise and courageous book raises the questions that none of us wants to think about . . . Remarkable.” ―
Peter Carey, The Sunday Times (UK)

“A deeply affecting, urgently important book--one not just about dying and the limits of medicine but about living to the last with autonomy, dignity, and joy.” ―
Katherine Boo

“Dr. Gawande's book is not of the kind that some doctors write, reminding us how grim the fact of death can be. Rather, he shows how patients in the terminal phase of their illness can maintain important qualities of life.” ―
Wall Street Journal

Being Mortal left me tearful, angry, and unable to stop talking about it for a week. . . . A surgeon himself, Gawande is eloquent about the inadequacy of medical school in preparing doctors to confront the subject of death with their patients. . . . it is rare to read a book that sparks with so much hard thinking.” ―Nature

“Eloquent, moving.” ―
The Economist

“Beautiful.” ―
New Republic

“Gawande displays the precision of his surgical craft and the compassion of a humanist . . . in a narrative that often attains the force and beauty of a novel . . . Only a precious few books have the power to open our eyes while they move us to tears. Atul Gawande has produced such a work. One hopes it is the spark that ignites some revolutionary changes in a field of medicine that ultimately touches each of us.” ―
Shelf Awareness

“A needed call to action, a cautionary tale of what can go wrong, and often does, when a society fails to engage in a sustained discussion about aging and dying.” ―
San Francisco Chronicle

About the Author

Atul Gawande is the author of several bestselling books: Complications, a finalist for the National Book Award; Better; The Checklist Manifesto, and Being Mortal. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Founder and Chair of Ariadne Labs, a joint center for health systems innovation, and Lifebox, a nonprofit organization making surgery safer globally. He is also chair of Haven, where he was CEO from 2018-2020. He and his wife have three children and live in Newton, Massachusetts.

Product details

  • Publisher ‏ : ‎ Metropolitan Books; Reprint edition (September 5, 2017)
  • Language ‏ : ‎ English
  • Paperback ‏ : ‎ 304 pages
  • ISBN-10 ‏ : ‎ 1250076226
  • ISBN-13 ‏ : ‎ 978-1250076229
  • Item Weight ‏ : ‎ 2.31 pounds
  • Dimensions ‏ : ‎ 5.35 x 0.8 x 8.15 inches
  • Customer Reviews:
    4.7 4.7 out of 5 stars 47,514 ratings

About the author

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Atul Gawande
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Atul Gawande is the author of three bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist Manifesto. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker since 1998, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won two National Magazine Awards, a MacArthur Fellowship, and been named one of the world's hundred most influential thinkers by Foreign Policy and TIME. In his work as a public health researcher, he is Director of Ariadne Labs a joint center for health system innovation. And he is also co-founder and chairman of Lifebox, a global not-for-profit implementing systems and technologies to reduce surgical deaths globally. He and his wife have three children and live in Newton, Massachusetts.

You can find more at http://www.atulgawande.com.

Customer reviews

4.7 out of 5 stars
47,514 global ratings

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Customers say

Customers find the book well-written and compelling. They find it thought-provoking and insightful, dealing with important end-of-life issues and quality of life considerations. The author uses real-life stories about patients to illustrate the topic in a realistic way. Readers describe the pacing as moving and exciting, keeping them riveted from start to finish. The book explores better models of senior care and hospice care.

AI-generated from the text of customer reviews

4,517 customers mention "Readability"4,363 positive154 negative

Customers find the book easy to read. They praise the author's fluency and compelling writing style. The book provides valuable information in a personal, understandable way. Readers appreciate the author's straightforward storytelling and research references.

"...The author writes on the subject fluently and beautifully and in a very compelling and empathetic way...." Read more

"...BEING MORTAL mirrored out experience. An excellent book and one I would recommend be read by all medical students, nurses and us the family members..." Read more

"...is a brilliant and deep look at the “…still unresolved argument about what the function of medicine really is—what, in other words, we should and..." Read more

"...I don't mean to be overly-critical of a fine book with many fine and heartfelt ideas...." Read more

3,805 customers mention "Thought provoking"3,714 positive91 negative

Customers find the book thought-provoking and inspiring. They say it provides good insight into understanding death and the important questions of life. The innovative solutions are encouraging and moving. Readers mention the book offers excellent guidance and is one of the most important, beautifully written books.

"...the subject fluently and beautifully and in a very compelling and empathetic way. Here are some key takeaways I took from it:..." Read more

"...The book is a road map of sorts into those in their precious last months, weeks or days in the life...." Read more

"...The poignant stories are page-turners. The innovative solutions—inspiring and encouraging...." Read more

"...Dr. Gawande's other writings as well, and they are deeply honest, thoughtful, non-arrogant and constructive. This book is no exception...." Read more

825 customers mention "End of life issues"812 positive13 negative

Customers find the book helpful for addressing end-of-life issues. It helps them consider their own mortality and how to die with grace. The author's compassionate approach opens new ways to discuss end-of-life wishes, which can change their views on terminal illness and aging.

"This is an important read on what human well-being means and encourages us to confront the inevitable: death...." Read more

"...BEING MORTAL speaks to the issue of dying from two approaches diverse approaches, facing the reality and living with a chronic illness with a new..." Read more

"...as well, and they are deeply honest, thoughtful, non-arrogant and constructive. This book is no exception...." Read more

"...Life is precious, not just for us but for all humans. What these people go thru on their life journey will in some aspects also happen to us...." Read more

427 customers mention "Authenticity"427 positive0 negative

Customers find the book authentic and honest. It uses real-life stories about patients, including the author's own father. The book provides personal insights and examples from the author's life and those of his patients.

"...BEING MORTAL allows the patient, family and fiends the opportunity to have a final bonding...." Read more

"I've read Dr. Gawande's other writings as well, and they are deeply honest, thoughtful, non-arrogant and constructive. This book is no exception...." Read more

"...is in making the reader feel the raw emotions and yet the factual situations through each of these stories...." Read more

"...Many wonderful anecdotes and a few warnings about our end game." Read more

196 customers mention "Pacing"159 positive37 negative

Customers find the book compelling and engaging from start to finish. They appreciate the writing style that keeps them riveted from start to finish. The journey of the author to realize that people can accept end-of-life issues is exciting and spellbinding. Readers mention it helps strengthen relationships, reduce suffering, and increase compassion.

"...The Checklist Manifesto” moves eloquently through medicine, aeronautics, and sky-scraper construction—noting why checklists will make or break a..." Read more

"...Because I am still well and able to get about, live my life as independently as I am able, I would like my daughters to read this book. Soon...." Read more

"...This is one of the most important, moving and beautifully written books you may not want to read because of the subject matter: the way we deal with..." Read more

"...This is a powerful and moving book. Thank you, Dr. Gawande for your compassion and showing us that we have a choice." Read more

178 customers mention "Care for the elderly"178 positive0 negative

Customers appreciate the book's insights into care for the elderly. They find it helpful for caregivers, patients, and families. The book explores better models of senior care, hospice, and compassion for the aging. It is inspirational for health and aged care workers, patients, and their families.

"...beautifully written book for all who are aging and caring for aging loved ones and parents. Dr. Gawanda explains the limits of medicine and..." Read more

"...They can be fulfilled by hospice or palliative care, humane "homes" for disabled individuals and the elderly and creative..." Read more

"...freedom and extend meaningful life because they leave patients with purpose and dignity...." Read more

"...He provides a brief and helpful questionnaire, employed by palliative and hospice care specialists, with examples of their usage...." Read more

149 customers mention "Aging"129 positive20 negative

Customers find the book helpful for understanding aging and death. They appreciate the clear presentation and how it helps them deal with the life cycle. The book covers everything from old age care to coping with terminal illnesses, and provides a clear-eyed look at ageing and dying.

"...--- This book is a must read : This is a clear eyed look at ageing and dying , & this book has the courage & compassion to look into..." Read more

"...These models allow maximal freedom and extend meaningful life because they leave patients with purpose and dignity...." Read more

"...It demystifies aging and death, and helps us understand the choices that we will have to make, for ourselves and for others...." Read more

"...My 95 yr old mother is in a nursing home. This helps me deal with the life cycle." Read more

250 customers mention "Depressing content"159 positive91 negative

Customers have different views on the book's content. Some find it emotional and funny, while others consider it depressing and unrealistically optimistic.

"...] Hilarious graphic memoir of parental caregiving, by Roz Chast. Everything you felt but dared not say!" Read more

"...Even suffering is not without value, though its relief through skilled practitioners using the gift of medicine is cause for thanksgiving to God...." Read more

"...They are stories that cover the full biographical, emotional, and psychological spectrum of people caught up in the crises of terminal illnesses...." Read more

"Grieving and understanding. Well-written. I have purchased two more for friends." Read more

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Top reviews from the United States

  • Reviewed in the United States on December 15, 2024
    This is an important read on what human well-being means and encourages us to confront the inevitable: death.

    The author writes on the subject fluently and beautifully and in a very compelling and empathetic way.

    Here are some key takeaways I took from it:

    1. Death and dying are becoming more prolonged and complex. Modern medicine is keeping many of us alive for longer.

    2. However, we still haven’t figured out how to deal with this new(ish) reality and how to have helpful conversations about dying. Indeed, our failure to do so may be accelerating death.

    3. Among what scared people about death is not death itself but dependence on others and loss of autonomy and independence.

    4. There are many different types of care for the dying, including nursing homes, assisted living communities, hospices etc.

    5. A medicalised and clinical approach to conversations around dying does not honour well-being of the individual.

    6. We need to have more “interpretive” ways of talking about dying. That includes asking people what they would like to prioritise if time is running short; what trade offs they are willing to make, and what level of being alive they are willing to tolerate.

    7. There are different organisations doing different things when it comes to caring for older adults. Sometimes these organisations do not prioritise the older adults’ well-being. A relentless focus on safety might render a cloistered life unbearable.

    8. It is essential to consider what the older adult wants. These are difficult conversations to have but they are important to help ensure that as many of us as possible can reach the end of our lives in dignity and well-being.

    Highly recommended.
    11 people found this helpful
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  • Reviewed in the United States on February 11, 2015
    Talking about ones mortality is a definite conversation stopper at many gathering. In our society with the rapid growth of medicines which can cure most diseases or at least elongate the process the reality of dying is pushed well into the future. Death is not an "up" subject, we'll find a way to get around its reality.

    BEING MORTAL is written with great compassion and wisdom. Dr. Atul Gawande considers both sides of the issue very throughly from the perspective of first the doctor who is the "fixer" of all things medical. All to often our Doctor is locked into the cure, a full on no holds chemical battle with the illness and is not able or will ing to address with the patients the fact that this illness will cause the patients death. It is not going to go away. Many doctors are unable to early on tell the patient that this illness is fatal, you will die once these interventions are exhausted. That conversation is not in their "black bag." The book addresses dying with very personal stories, the experience of patients living with chronic or measurable fatal illnesses. It goes beyond the common, "medical intervention" to look at accepting that this illness is fatal and prolonged suffering with it is optional. When do we, the patient, draw the line in the sand and say, "I'm not going to continue to fight a losing battle, I believe there is another path to follow."

    The journey I shared with my wife Helen is passionately told throughout the book. There came a time when she had had enough suffering from the standard interventions, "chemo, to surgical procedures." Finally she said that had to stop. Many lines in the book quoted verbatim what we had heard from our doctor, "well there is another new more aggressive chemo we can try now", wait, hold on we've been through three already. BEING MORTAL speaks to the issue of dying from two approaches diverse approaches, facing the reality and living with a chronic illness with a new focus placed on quality of life. Yes, you can die of a chronic illness and still have comfort, control and dignity. At one point in the book Dr. Gaqande puts both sides of the argument in sharp focus when he writes from his honest and realistic viewpoint; "The medical approach applies its own pressure always remaining an all or nothing, in one direction, toward dong more, because the only mistake clinicians seem to fear is doing too little. Most have appreciation that equally terrible mistakes are possible in the other direction - that doing too much could be no less devastating to a person's life." Many readers of this book will understand this point at a very personal level."

    In the book Dr. Gawande uses statistics in such a way that they become personal and allow you to ponder where we are in 2015 in regard to facing death as a society. From the book one gets the feeling that there is strength in getting involved early with a Hospice program. He states, " those who...entered Hospice far earlier, experienced less suffering and at the end of their lives - and at they lived 25% longer. For some making the decision to die under Hospice care in not an option they will exercise. However, the experiences of many people have had over the past twenty years are beginning to make the case. They speak to the merits of pain management, end of life quality of life.

    Dr. Gawawda has made it possible for my family to discuss the dying process in real time. We are spending time while we are all healthy pondering the issues together knowing that they surely one day will be as we say, "up close and personal." The book is a road map of sorts into those in their precious last months, weeks or days in the life. For a family about to see a loved one pass on and become an ancestor. BEING MORTAL allows the patient, family and fiends the opportunity to have a final bonding. I know my family and Helen's friends celebrated her life the entire seven months she was dying of cancer. Through it all we had many happy moments. BEING MORTAL mirrored out experience. An excellent book and one I would recommend be read by all medical students, nurses and us the family members who will share the journey with them.

    Tom Wicks
    6 people found this helpful
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  • Reviewed in the United States on November 16, 2018
    Apparently, I’m a slow learner.

    You would think that when your daughter-in-law encourages you to read a book—you would read it. Ditto book recommendations from your wife.

    Melinda and Joanne—sorry it took me a year to read this. But thank you. Because “Being Mortal” is now on my Top-10 book list for 2018.

    In this riveting book, Dr. Atul Gawande reminds us: “People die only once.” So when facing fork-in-the-road sick and dying decisions, “They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and escape a warehouse oblivion that few really want.”

    “Being Mortal: Medicine and What Matters in the End” changed—totally changed—my thoughts about end-of-life decisions. Whew. On one level, I agree that this New York Times bestseller (7,000 reviews on Amazon!) is a brilliant and deep look at the “…still unresolved argument about what the function of medicine really is—what, in other words, we should and should not be paying for doctors to do.” Yet on another surprising level, this writer (four bestsellers), surgeon, and public health leader—delivers fresh management and leadership insights in every chapter.

    CUSTER OR ROBERT E. LEE? The author says that medicine’s job is to fight death and disease—the enemy—but that the enemy eventually wins. “And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.”

    Yet Gawande admits, “More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, ‘You let me know when you want to stop.’ All-out treatment, we tell the incurably ill, is a train you can get off at any time—just say when. But for most patients and their families we are asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve.”

    What should families do? My suggestion: ask your doctor (like I did this week) if he or she has read “Being Mortal.” (He had.) Gawande notes that medical school taught him two styles of doctor/patient interactions: paternalistic and informative.

    The “paternalistic relationship” is the “priestly, doctor-knows-best model, and although often denounced it remains a common mode, especially with vulnerable patients—the frail, the poor, the elderly, and anyone else who tends to do what they’re told.”

    Doctors make the critical choices. “If there were a red pill and a blue pill, we would tell you, ‘Take the red pill. It will be good for you.’ We might tell you about the blue pill; but then again, we might not.”

    The “informative relationship” sounds good, at first. “’Here’s what the red pill does, and here’s what the blue pill does,’ we would say, ‘Which one do you want?’ It’s a retail relationship. The doctor is the technical expert. The patient is the consumer.”

    The down side? Doctors become “ever more specialized” and “We know less and less about our patients but more and more about our science.” He writes, “In truth, neither type is quite what people desire. We want information and control, but we also want guidance.” In his medical school, there was also the brief mention of a third type of doctor-patient relationship often labeled “interpretive.”

    “Here the doctor’s role is to help patients determine what they want. Interpretive doctors ask, ‘What is most important to you? What are your worries?’ Then, when they know your answers, they tell you about the red pill and the blue pill and which one would most help you achieve your priorities.”

    Makes sense right? Gawande notes that this relationship is also called “shared decision making” and added, “It seemed to us medical students a nice way to work with patients as physicians. But it seemed almost entirely theoretical. Certainly, to the larger medical community, the idea that most doctors would play this kind of role for patients seemed far-fetched at the time. (Surgeons? ‘Interpretive?’ Ha!)”

    But two decades later, the author describes a meeting with his father (also a surgeon) and his father’s neurosurgeon. The task: review the MRI images of his father’s giant and deadly tumor. The neurosurgeon “saw himself as neither the commander nor a mere technician in the battle but instead as a kind of counselor and contractor on my father’s behalf. It was exactly what my father needed.”

    To get the conversation going in your family, maybe insert a reminder into your Thanksgiving prayer next Thursday that everyone around the table will die only once! Then, mention this book as required reading for at least one family member. (“Grammy—please pass the turkey and that Being Mortal book.”)

    Dr. Gawande is an amazing writer. The poignant stories are page-turners. The innovative solutions—inspiring and encouraging. I’ve already re-told many of the memorable fork-in-the-road stories (tears will flow) to friends and colleagues and ordered the book for several friends. Be sure to read the hilarious story of the very creative nursing home that added two dogs, four cats, and 100 parakeets! (Memo to Purchasing: Next time, order the cages before the birds are delivered!)

    I should have jumped on this 2014 book much, much sooner—because I still rave about Gawande’s 2010 insightful bestseller, “The Checklist Manifesto: How to Get Things Right.”

    I had no idea that there were checklist connoisseurs! “The Checklist Manifesto” moves eloquently through medicine, aeronautics, and sky-scraper construction—noting why checklists will make or break a venture. For example, Boeing’s checklist expert uses “pause points” when designing checklists for pilots in crisis. Within each pause point, he limits the checklist to between five and nine items.

    As a staff writer for the New Yorker, Gawande’s latest article, “Why Doctors Hate Their Computers,” was published on Nov. 12, 2018. You can read or listen to the article online. (Customer Bucket Pop Quiz: Are computer systems for the doctors or for the patients?)

    And—get this—Gawande is also CEO of the health care venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase to deliver better outcomes, satisfaction, and cost efficiency in care. Stay tuned!
    139 people found this helpful
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Top reviews from other countries

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  • Jeff Baldwin
    5.0 out of 5 stars critical read
    Reviewed in Canada on December 11, 2024
    Emotionally very hard to read but so helpful as we all prepare for this time. For most of us who are elderly, this is an insightful rollercoaster ride/read.
  • Rich Vélez
    5.0 out of 5 stars Excelente libro. Todos lo deben leer
    Reviewed in Mexico on August 12, 2024
    El tema es muy importante para todos. Nos ayuda a ver con nuevos ojos cómo enfrentamos las enfermedades y la vejez.
  • Pedro Henrique Fontenelle Albuquerque
    5.0 out of 5 stars Muito bom para os que estudam medicina
    Reviewed in Brazil on February 14, 2023
    Bom produto, muito bom custo x benefício. O Vendedor é rápido e eficiente. Recomendado.
  • Fiammetta Zanetti
    5.0 out of 5 stars Bellissimo libro
    Reviewed in Italy on April 15, 2023
    Ottimo libro da leggere sia per chi lavora nel settore sanitario che per chi si interessa del tema del fine vita.
  • J. Drew
    5.0 out of 5 stars Gawande should be made a saint - great book
    Reviewed in the United Kingdom on August 12, 2022
    I thought I once picked up this book and it contained the quote by Bette Davis saying ‘old age ain’t for sissies’ which I loved. I also thought it contained another quote about who wants to live to 99 with a whole range of health problems that might include poor eyesight and hearing loss, on a dialysis machine and taking every medicine under the sun just to keep breathing - answer; the person with all this who is aged 98. However, neither of these are in this book so I thought I would add them to this review. I love both those quotes and would love to know what book I did actually read these quotes from.
    - In this book the author, Atul Gwande (a man someone should make a saint) has written a book about death that is full of hope. He looks at how we can better manage and have a good death. Previously most of us died at home but now the majority of us die in hospitals attached to drips and adding to the prolonged memory of end-of-life care.
    - Man has spent most of the 200 - 300,000 years of existence on this planet, with an average life expectancy of living to the ages of 30 or 40. It is only in the last century that we start to live in longer lives and move from living to an average age of 30 or 40 to an average age of 70 or 80, and our bodies have to adjust the fact that we are ageing and this is not necessarily a natural course of events but we are kept alive for these long periods of time for many people through medicines and healthcare and understanding how we can do this. However, do we really want to then end our final few years separated from loved ones, living in an institution and buried by a mass of tubes keeping us barely conscious.
    - This book is a fascinating look at how we view ageing and how we might wish to end our days or those of a loved one. Ending up in an institutions such as nursing homes have been likened to a similar institutionalisation that you would resemble prisons or mental facility for people with mental health problems, it's not dignified, it's often neglect where old people lose all the sense of dignity that they may have had whilst being independently living on their own, and be given nightdresses and institutionalised clothes with wardens going around making sure you behave in a certain way and do the right thing and end up being treated like a child or someone beneath them. Just because you're in an institution where you are cared for and there is a lot of care going on doesn't mean that they can make you fit in with scheduled events and where everything is regimented once they have your money.
    - However if the alternative is to put the black the burden on a family member such as a daughter who is usually in often is, then they are now the carer and provided medicine, providing meals, and having to deal with people alongside their house rules. So the emphasis of care provided by a carer can be equally bleak and difficult on both parties such as the family member and the older person who requires care.
    - So if we don't like institutions and we feel we can't put the burden of care on family members, what is the solution? Another idea suggested is assisted living where people have their own houses and their own privacy, dignity and ability to control but also have the opportunity to meet other people, and have basic care when provided and necessary. Old people aren't called patients but are known as tenants and in this setting might be a better alternative. Even when people are old and frail and possibly losing memory and some faculties, we still need to ask the question: what is it that makes life live it worth living and what is a good life even when we might have other areas of concern and be old and frail.
    - Rachel Carson was somebody who looked at Maslow's motivation of needs approach and noted that actually it was how perspectives can change for older people because they have a different perspective on life than younger people do. When young, you feel they're going to live forever and you're motivated by work goals and making a career. But as you age, your perspectives change - many people get less depressed and feel the more important things are close relationships with families and friends. Your days are limited, you become aware of the fact, your perspective on what’s important changes. In fact, how we perceive everything can help us lead better lives.
    - However many of the institutionalised independent living places really turned into more like institutions. For what is a better life after all many of these frail people suffer from the three plagues of boredom, loneliness and frailty so could we turn places such as nursing homes into something that tries to manage boredom, loneliness and helplessness? The author also looks at life and what it means that we have to care and be connected to one another and we'll see what will happen to people even after we die. There are very few people that would ever want to imagine that when they die, an hour later everyone else would be wiped off the planet earth, we care what will happen to people after we've gone and for some, dying is the gift that they can help those left behind feel better about the death of a parent or loved one.
    - The book then switches to a young mother who is giving birth to a baby but through that operation they discover that she has lung cancer and it is terminal. She is a non-smoker (note: 50% of people who have lung cancer are non-smokers). She was then given several courses of treatment and to which she will still probably live no more than a year. The question is what kind of care do we want to give to people who are in the final year of life as 25% of all Medicare in America is spent on people who will have one year left of life and the majority of that money will be spent on the last two months of care before the person dies. Often when people are in the final years or stages of an incurable disease the questions we should be asking are what would they want from this life at this time and what is important. The answers are often creating understanding or close relationships with the people in their lives, filling their lives with some meaning and closure and it's not necessarily about keeping them alive pumped full of drugs, in and out of consciousness in a hospital bed, sent via tubes and barely registering what's going on. However, we don't ask these questions and we should think, is this how I really want to spend my final weeks or days in this way.
    - End-of-life care in terminally ill patients who particularly might have less than a year to live, are often under the management of doctors who continuously try to find something that might extend life by a few months rather than the years they expect. Many patients think further treatments might extend and offer them an extra 20 years of life when in actual fact almost all statistical evidence says that it might give them all three months. When patients are then given palliative care from trained nurses who without the need to stop curative care they can often form better decisions because people start asking them what is important in their life and help them to understand the realities of what is going to occur. Fascinating stuff that we should think about. In many societies where palliative care is the norm rather than further courses of treatment - particularly in countries that don’t have access to the medicines available in America - life expectancy is often longer than those on relentless courses of expensive treatments. It reminds me of a joke in regards to why they stick steel nails into coffins of people who have died of cancer, it's to stop the oncologist coming up with one further bout of treatment. After reading the account of one young lady's decision-making and the whole family's inability to accept what was going on, her life's end of life care was just one about an excessive set of treatments without necessarily looking at what is the best way to die. These are questions we need to be asking ourselves. And palliative care nurses could be the best people to do this.
    - What is also interesting is the end of life care in regards to hospice treatment actually seems to have longer life expectancy than the care that has just given through medical intervention, not by years and only weeks or months, but also it may lead to a better death
    - If we have to face bad news we also have to think about what we want. Do you want the doctor to inform us about the best medical decisions we can make or do we want the doctor to listen to our fears and try to manage that and address those fears. Hope that a better way would be to give us information and guidance but also try to help us make the decisions that we need to do so even a model of that is listening to the patient, giving advice but tempering that advice with what our fears and needs actually are within relation to possible surgery or further treatment. And I guess it's important to remember that lots of medical practitioners just want to try and fix a problem and those conversations are hard.
    - Though Gawande tells many stories in this book - he also talks of his own experiences and of his own family (particularly his dad and grandad). It really helps to crystalise the message that he is telling with this book.
    - I love the author's approach by starting with three words when you want to relate and discuss something that might be hard to tackle, and those words are "I am worried”.
    - The most amazing thing about this book that is about death is that it's also about a better life to gain some insight and solutions to how we can die - and as Jim Morrison once sang “no one here gets out alive” so it's worth asking these questions now rather than waiting until it's too late. A recommended book on death that tells us a lot about how to live.