by Peggy Shafer
Death and dying are high on the squick factor scale for most of us, and when we get right down to it, our ultimate fear isn’t of dying itself but of all that can happen to our bodies and minds months or years before we toddle off and vanish into the sunset. Perhaps we prefer to imagine that we will die in our sleep at 97 after completing a triathlon, but most of us who will be fortunate enough to live well into old age—fortunate because people in the last decades of their lives report the most satisfaction with their lives—will, in the end, experience a precipitous decline.
Reading the first half of Gawande’s book can be a somber excursion, but his beautiful, often lyrical, prose eases our way through the parts describing the grim history of our “care” for the frail elderly, the modern incarnation of which is assuring health and safety at the cost of autonomy, privacy and meaning.
In comparison, reading the second half of Being Mortal is an uplifting experience. Already there are scores of home-like living situations for frail people where the provision of privacy, autonomy and human—and animal—connections lengthen lives, motivate people to walk rather than waste away in wheelchairs and reduce prescriptions for all medications including those that render people confused and helpless. Gawande urges us to demand humanizing changes to all assisted living and nursing home environments and to insist that they change direction from fighting for longevity at all costs to fighting for what makes life meaningful.
Gawande’s latest book is laced through with intimate and moving stories of patients and of his own father’s decline and death and how they, and the innovators he learned from, radically changed the ways in which he conversed with patients close to the ends of their lives. In the final pages of the book he writes, “the aged…have priorities beyond being safe and living longer…the chance to shape one’s story is essential to sustaining meaning in life. We have the opportunity to refashion our institutions, our culture and our conversations in ways that transform the possibilities for the last chapters of our lives.”