Being Mortal- a review

Being Mortal 

Medicine and What Matters in the End

Atul Gawande- Being Mortal-book cover

 

 

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I read Being Mortal by Atul Gawande, M.D. (To be exact, I listened to the audio version)

Dr. Gawande is a surgeon at Brigham and Women’s Hospital in Boston, Massachusetts and professor at Harvard Medical School. He writes for The New Yorker and has authored three other bestselling books.

In Being Mortal, he explores the way most people now live, age and die and for the most part it’s not a pleasant prospect.

Caring for elderly people

As people age and lose independence due to frailness, illness, mental decline and poverty, they often also lose whatever is most important to them- their home, pets, hobbies, possessions. And these losses often occur to protect them from harm as they progress into assisted living centers, nursing homes and hospice.

Dr. Gawande describes how his  family in India expected  to care for their elderly relatives, which differed from what he saw happen when they immigrated to the United States. After becoming a physician, he recognized that our care of the elderly often robs them of the well-being that he sought to promote in his practice.

He wondered how it can be done differently. To find out, he interviewed people who are developing novel ways to provide care to older people, care that preserves their independence, dignity and choices while still keeping them safe and protected.

Most of us either have relatives or friends facing these decisions, or are facing them ourselves. If not now, we all will eventually. Whichever the case, this book shows

“how the ultimate goal is not a good death but a good life-all the way to the very end.”

 

woman sitting in a cemetery

photo from the Lightstock.com collection, an affiliate link

Caring for dying people

Finally, Dr. Gawande discusses end -of -life care- that is, care when a disease has become terminal and a cure is no longer likely. Sometimes it is difficult to determine when that occurs. As he says, it is rare in medicine when there truly is “nothing more we can do”.

However, just because we can do something, doesn’t mean we should. Some treatments, rather  than extending life just prolong the suffering. Still it is heart wrenching for patients and families, along with their doctors, to decide that it is time to forgo treatment and instead opt for palliative care, with or without hospice.

(Palliative care focuses on symptom management and social and emotional support for patients and families.)

 

Dr. Gawande poignantly describes this process by sharing in detail his  father’s cancer diagnosis, treatment, progression, hospice care and death. He shows how difficult a process this can be, given that even he and his parents, all of whom are physicians, struggled to come to terms with the reality of terminal illness and the dying process. Though they were all familiar with and experienced in dealing with the medical system, they still felt unprepared to face the decisions required at the end of life. But in the end, both he and his father felt at peace with the outcome and Dr. Gawande senior did experience “a good life-all the way to the very end.”

 

Atul Gawande on Priorities, Big and Small– a podcast interview with Tyler Cowen

 

Other books by Dr. Gawande

Complications : A Surgeon’s Notes on an Imperfect Science

In gripping accounts of true cases, surgeon Atul Gawande explores the power and the limits of medicine, offering an unflinching view from the scalpel’s edge. Complications lays bare a science not in its idealized form but as it actually is―uncertain, perplexing, and profoundly human.

 

Better: A Surgeon’s Notes on Performance 

The struggle to perform well is universal: each of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives may be on the line with any decision.

Atul Gawande, the New York Times bestselling author of Complications, examines, in riveting accounts of medical failure and triumph, how success is achieved in this complex and risk-filled profession

 

The Checklist Manifesto:How to Get Things Right

Atul Gawande shows what the simple idea of the checklist reveals about the complexity of our lives and how we can deal with it.

 

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More news about breast cancer

This blog reported  the update in screening mammography guidelines by the American Cancer Society recently released. In other news about breast cancer-

Researchers at Cornell University see a potential link between obesity and breast cancer. Obesity may change the adipose (fat) tissue in the breast making it more susceptible to malignant (cancerous) changes. This may explain why breast cancer is sometimes more severe in patients who are also obese.

Body mass index chart

A BMI OF 30 or more represents obesity. BMI Chart created by Vertex42.com. Used with permission.

Because soy has similar effects to estrogen, there was concern that it might predispose women to breast cancer. but in a review of 7 medical studies, there was no association between dietary soy and breast cancer. Women who had previously had breast cancer has less risk of recurrence and lower mortality.

A 6 year study of 4000 women found a lower incidence of breast cancer in women who ate a Mediterranean diet supplemented with extra-virgin olive oil or nuts, as compared to a group following a “low fat” diet. (However, only 35 cancers occurred during this time, so the numbers are not significant enough to draw definite conclusions.)

bottle of olive oil

The Mediterranean diet provides many health benefits.

The Canadian National Breast Screening Study of almost 90,000 women found that smoking, especially long term smoking prior to a first pregnancy, increased the risk for breast cancer. 

no smoking sign

Smoking adversely affects health in many ways.

The New Generation Breast Cancer Book

This is an affiliate link.

Dr. Eliza Port, a breast surgeon at The Mount Sinai Hospital has written this guidebook on breast cancer which shows patients

“How to Navigate Your Diagnosis and Treatment Options-and Remain Optimistic-in an Age of Information Overload “

In The New Generation Breast Cancer Book , Dr. Port “describes every possible test and every type of doctor visit, providing a comprehensive, empathetic guide that every newly diagnosed woman (and her family) will want to have at her side.”