One of my resolutions for 2021 is to read more books, and as a pre-medical student, it’s fitting that my first read was Being Mortal: Medicine and What Matters in the End. Renowned amongst those in the healthcare sphere and beyond, Being Mortal was written by Atul Gawande, an American surgeon, author, and researcher of public health. Through reflections on the experiences of his patients and family members as well as on relevant research findings, Gawande reveals the pitfalls of modern medicine in its approach to end-of-life care. Rather than just preserving life and focusing on physical and physiological well-being, Gawande implores people (especially healthcare professionals) to tend more to the human spirit as patients near the end of their life.
Modern medicine in the United States has revolutionized everything as we know it. As medical care progressed throughout the latter twentieth and early twenty-first centuries, a rectangularization of society ensued. Life expectancy increased as new ways to treat injuries, infectious diseases, and ailments of age developed. As a result of this triumph of medicine, the demographic pyramid of society--with the base constituting young children and the peak containing a small number of elders--went through a rectangularization, with the number of people growing to old age increasing exponentially. A residential shift occurred as well. The percentage of individuals over 65 who lived with a child decreased from 60% to just 15% from the early twentieth-century to 1975.
People are now living independently for long periods with their own routines and ways of living life. It is no surprise then that the rate of depression and discontent among nursing home residents is at an all-time high. Gawande recalls how his wife’s grandmother Alice spent her last years of life in an assisted living apartment and later a nursing home. She grew increasingly despondent because she was uprooted from her home into spaces where she could no longer control what time she woke up, what she ate, or what activities she wanted to partake in. It is normalized in American culture to place our elders in a nursing home when we deem they are no longer able to live without outside medical assistance. Through this normalization, however, we fail to respect the autonomy of our seniors.
At its core, Being Mortal encourages us, whether we are in the medical field or not, to place more value on palliative care or caregiving that optimizes quality of life when living with complicated illnesses or complications (as many seniors often do). End-of-life interventions that only aim to extend one’s life without improving its quality and assisted living facilities that limit one’s autonomy should not be the be-all and end-all approach to our growing aging population. When spending time with my grandparents and the other seniors in my life, I will be sure to keep the lessons I learned from Gawande’s novel in mind and focus on helping them fight for what they find to be meaningful in their lives.