Read what unsettles you. Book review: Being Mortal, Illness, Medicine, and What Matters in the End, by Atul Gawande

9781846685828

I may not read very diversely.

Scratch that.

I know I absolutely don’t read “diversely” (in any sense of the word) despite the fact I would like to believe I do, and often try to push my own boundaries. Often, that means, when I’m not picking a book by its’ cover, forgetting that most covers are now designed to resemble another book of the same genre you just bought, or books I know I will like, for comfort, or books by authors I’ve already read,… So, not so often then. And I used to be better at this: I would go to the library and pick at least 5 of the authorized 10 books you could borrow that would be books I knew nothing about, picked at random in shelves, because I read a few pages in the middle, liked the sound of the title, anything. Now I do it less frequently, probably because the number of authors and books I’ve discovered through this medium means there are so many books I want to read – that I already know of – that I don’t have the willpower to discover entirely new ones. Anyway, that is one of my 99 book related problems, you would say, and absolutely not related to this book in particular.

But it is a predictable choice, is what I should have said were I to use fewer words than this first paragraph ever needed: I’m a doctor (still sounds weird!), I’ve worked in palliative care, I’m interested in questions about end of life and the worth of living, and how to help those who face death at the best of my abilities. So I picked this book. See, not diverse at all.

And it is a very good book. First, it’s well written (If I were to be sarcastic I would add “…for a surgeon”, but that would be classical inter-medical-species bickering, and in any case one would argue that Gawande is now about as much an author as a surgeon.), and it is about an important subject matter, for “anyone about to age and die”, so a lot of us. It makes a great case for the importance of palliative care training of health care professionals in an ageing world, it studies the effects of the ageing population and what it means for the end of our lives, it gives individual histories of what people value at the end of their lives – underlining the vast array of what might be considered “a life worth living”, by people living them, which I’ve always felt should be the first thing you say when trying to discuss subjects going from whether or not people should grow old in hospices to whether assisted suicide should be allowed: What an individual might consider a life worth living depends almost entirely on that individual.

So it is everything I expected, and in that, it is a marvellous book, read it. (See, I can be direct when I want to).

I have no problems with it, only with myself, for, as comforting as it may be to read a book that is a mirror of your own certainties, it didn’t teach me anything, it didn’t bring me out of my comfort zone, it didn’t surprise me – it could have, had Gawande taken a firm stand concerning for example therapeutic measures to shorten the suffering of people dying, which he didn’t, and it is comprehensible that he did so, after all it is perhaps the trickiest subject you could talk about, and it wasn’t his purpose. So what I was saying before still holds: It is a great book and I would love for people to read it, I’m happy to have it in my bookshelf to pass it around, but I, myself, have only learned what I already knew.

Perhaps it is time to go back to the library and pick books at random. A lot of those were disappointments, of course, but as Gavande says: “the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?” The important questions, at any time in your life, are indeed those. And one of my many fears is precisely not to learn enough, to build a fortress of certainties that doesn’t allow me to be unsettled any more, and, as Thoreau puts it “and not, when I came to die, discover that I had not lived“. So perhaps this book has thought me something in the end: go for what unsettles you, a little more frequently.

One more quote to convince you, if need be:

“Our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”

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