Book Review of ‘Being Mortal’

The medicine man, his roots, and how he looks at death

 

Many think that a doctor is the devil himself; or worse. To those who do, let us introduce Dr Atul Gawande. The man is more than a medicine man. He is a philosopher. He sees a malfunctioning system and does his best to correct it. He cares not only that you live; but, more importantly, how you live. And, even more important than that, how you die: with or without dignity. Prepared or left to the elements? His book, Being Mortal, is a wake-up call.
Please prepare yourselves. While the introduction is eminently readable, the next few chapters tell you how close you—and everyone else—is to the precipice. It’s a scary read. Brace yourself. Time is ticking away. The Grim Reaper is on the lookout. 
 
Dr Gawande is the son of a doctor. He is the grandson of a farmer from India but was born and brought up in the US. His heart still has room for this far away place. He narrates a lot of family history. It is entertaining, if not very informative for us.
 
The introduction deals with his early days and how he became a doctor, including the usual trials and tribulations. A medico doing the red-eye shifts. He gets off the block with his first essay and the stories begin to unfold. Each one is about a new patient with the same old problems: either old and infirm or radically ill. Cancer takes the centre stage, often. The dreaded ‘C’ word is overworked. But, as a professional, one needs to face the truth, however unpleasant.
 
There are more than glimpses of personal travails, including a 110-year-old grandfather, who dies after falling off a bus! Then there are the other calamities, also closer to home. A wife’s relative or his own father. All have medical problems. So, what’s new? After all, Samuel Clemens had said that the only things certain in life are death and taxes. We are prepared for taxes. We know that they are necessary for a better quality of life for all. Then, what about death? Are we prepared? How many can answer that question truthfully? I cannot; Dr Gawande tries.
 

What Is Missing

It is for these that Dr Gawande’s book brings a measure of help. Unfortunately, and sadly, reading the pages, leaf after leaf, tells us what is missing. If it is so in America, how much worse is it in less developed countries? Is nursing care enough? What are the needs of the elderly? What is it that they want? Really want? There are no quick, or any sure-fire, solutions. Incremental changes, yes. To tell you now would not be fair to the author who has spent years in trying to do just that. What is it that people want at the fag end of their lives? One can be cynical, or over-smart, or cussed, or ambivalent or put on a show of disinterest. No one will, however, rest easy, the first few days, after reading Being Mortal.
 
Each chapter is actually a case study. Dr Gawande has travelled extensively to check on people and facilities. His notes must have been copious. Then, he is also an author of many other books. As one reads of his own exploits—that’s the correct word for his work—one wonders where the man get the energy and the time! He seems driven to make life easier for as many as he can.
 

Born in America, owning a set of wheels is everyone’s birthright. As also to motor around. Age withers, not the drive to drive. Until time takes its toll and one is forced to give up. Read about how the oldies die to get behind the wheel. How they need to be free. How they want their own space. And how, losing your mate after 50 years can be a weight too crushing to bear. The book is not a novel. It is not fiction, though one wishes it were. It asks the reader to come face-to-face with reality. 
 
A young doctor realises that he was confusing treatment with care. The two were simply not the same. One is the administration of pills and tonics. The other is a lot deeper. Which one is more effective is what Dr Bill Thomas determined. He, being a very poor student at school, teachers had given up on him. His greatest strength, however, was a thick skin. Dr Gawande is more circumspect. He calls Dr Thomas’ attribute, in the man’s own words, as ‘the ability to be rejected’ and not mind it. A total loss at studies, Dr Thomas won every sales contest because he did not mind being rejected. He knocked on one door after another: a hundred knocks and 10 will open. Ten open doors, one will buy. This is the salesman’s perennial challenge. Then his life changed; but not because of some enlightening experience. It was the whiff of beer, girls and good times, as dangled before him by an acquaintance. Where? At college. He joined it. He soon became a doctor. He worked hard; got a farm; was happy. Then, he took on a job at a nursing home.
 
Dr Thomas realised that independence was the crunch factor. He came up with radical ideas for the elderly. He brought in dogs and cats and… to tell more would be to spoil the fun of reading the one chapter that brings a smile to your face. Suffice it to say, medicine doses went down. Why that happened, and how, is the part that cannot be told.
 
There are many depressing stories but the book is a compelling read. Maybe, I am a masochist. No, I am not; but human suffering has a way of making itself tie you down. You want to know… ‘What next?’ Is there a way out? Is this how we will all go? Or suffer? Oh, my God, I’m past 70 already. Now what?
 
Sadly, the author has to deal with a tragedy very close to home. His own father is ill. How a doctor-son broaches the subject with a doctor-father. How they try to cheat the gods; delay as long as possible. But death catches up with all of us; sooner, rather than later. If this book teaches us anything, it is the boy scouts’ motto: ‘Be Prepared’. Life is never long enough. Get as much done while you have the time on your side. Hopefully, energy too.
 
The last chapter is, to me at least, disappointing. It is filmy. Dr Gawande returns to his roots to scatter his father’s ashes. It’s the done thing. No need to go over it in great detail. But then, to give the devil his due, the book may be aimed at American audiences who will find the ritual fascinating. Something akin to those who come from far and wide to see the ‘Towers of Silence’. One wishes that this chapter had been edited out, if only to allow for digestion of an almost religious tome. 
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