Book Review: Being Mortal, Medicine and What Matters in the End, by Atul Gawande

A personal recommendation from our President Martin J. Kossoff, CFP®, AIF®.

I cannot recommend this book enough, especially for those thinking about end-of-life care and decisions, and those who are already providing some care for older family members.

Author and surgeon Atul Gawande, MD, MPH, previously wrote The Checklist Manifesto, which also had a great positive impact on my personal and professional life. At Allegiant, we incorporated many of the ideas in that book into our investment process, and still use them to this day. Being Mortal is concerned with refocusing away from the medicalized experience that dominates so many last days for the dying, and instead on the quality of life as we near death. It asks medicine to make room for appreciating meaning and self-determination in one’s life - right up until the end. For me, it worked because of the strength of the narratives portrayed by many people in the book, and the clear and cogent writing that Gawande uses to build his case. No matter how far along each patient was, he discovered a universal desire for being happy at whatever level they were still able to achieve, whether spending time with loved ones, watching baseball, eating favorite foods, or playing board games with friends. It all sounds like an easy ask from each patient, but in truth we all know too many cases where friends and loved ones spent their last days under fluorescent lights in a hospital or nursing home, being unable to live out their days as we know they would have wanted to.
 
Medicine is not indicted. In fact, it’s praised for what it has achieved and what it is capable of - extending life, mitigating pain, sometimes even finding a cure. But there is too often a singular focus on what medicine might theoretically be capable of achieving, and the patient’s desire to live as long as possible feeds into that perfectly. And this focus comes with a cost - more procedures, more drug regimens, more hospital stays, less control over body, mind, and life.
 
This is not a tough book to read. This is an uplifting and mindset changing narrative of what the experience of dying could and should be like. In most cases quality of life while dying has veered far away from truly fulfilling the wishes of the dying. Gawande urges us to think not just about the medical urgency to keep the patient as safe as possible, but on the person as a whole, their desire for privacy, agency, independence, and control over their life, however they might define it. It’s not enough to keep someone well-hydrated, but unable to maintain cohesive thoughts because of prescribed pain meds - if they really just wanted to spend time talking with their family. It’s not enough to probe, scope, and scan, if all they want to do is live as normally as possible while they can. Certainly, there are those of us who will want to try every medical option available until time runs out, searching and hoping for a cure. No procedure becomes too risky, no side effect too much to bear, while just hoping for a cure. I might choose that path myself, to extend my life at all costs. I don’t have enough certainty to say for sure what I would decide given that possible reality. But I do know that after reading this book I am better prepared to ask the right questions and deal with those decisions. I believe this also makes me a better Wealth Advisor right now, more able to talk through these discussions with clients when needed.
 
Being Mortal helps color in those areas we rarely want to think about, and it does so in a well-written, engaging, and compelling manner. The sub-title, “What Matters in the End,” is exactly what this book will help you think about. What more can you ask?