Being Mortal: Medicine and What Matters in the End
DYING IS the easy part. People have been doing it with relentless regularity ever since human memory, and possibly before that. But here’s the tricky bit—not to mention a trifle confusing one: modern medical regimes today are geared to keep a body alive (or prolong a life to put it more gently) for an indefinite period of time, or till the insurance dries up.
Let’s not mention religion, priests or the promise of an after-life to sweeten the process, as these are areas that Atul Gawande, best-selling author and also a surgeon at Brigham and Women’s Hospital in Boston, US, doesn’t dwell upon. And this gives his book, Being Mortal: Medicine and What Matters in the End, a clean whiff of sanity of being a new-age guide to dying that has something for everyone. Gawande has been a staff writer for the prestigious New Yorker magazine since 1998. And in this book, he penetrates the inner world of the dying as succinctly as he puts his surgeon’s fibre-optic probe into a body cavity and declares: “Voila, here’s the malignant node!”
Needless to say, he’s far too sensitive a writer to actually use the words ‘dying’, ‘death’ or ‘dead’. It’s almost as if he knows they might frighten the average reader, particularly those living in America, where the more bizarre rituals of dying were satirised by British writers such as Evelyn Waugh in The Loved One and Jessica Mitford in The American Way of Death. He instead calls it “the modern experience of mortality”.
Even the title, Being Mortal, allows the reader to think that being in control of the process of dying is not just the right of an individual, but something to be encouraged. Gawande shows in case study after case study that medical advances and what he calls “the treatment and management of the terminally ill” have gone way beyond what Waugh and Mitford predicted. In the UK, it’s called the ‘Nanny State’; in the US, as described by Gawande, it could be called the ‘Twilight Zone’. The seriously ill—you don’t have to be necessarily old to be dying—are scanned and processed through electronically-operated systems, isolated in ICUs and monitored by machines.
Gawande’s aim is to educate and enlighten his audience rather than to frighten and sensationalise. The light touch he brings to his guided tours into the mysterious world of the operating theatre, or the recovery room—using words such as ‘catherization’ or ‘intubation’—calls to mind the early sections on medical jargon that the Reader’s Digest used to carry with headings such as I am John’s kidney or Jane’s esophagus. Here, it’s more in the nature of “I am John’s inoperable tumor” or “Molly’s malignant melanoma”. It’s all up, close and personal. For instance, in one of the later passages when Gawande has to confront the mortality of his own dad, a dynamic individual and a highly successful doctor himself, Gawande describes how he had to ‘catheterise’ his helpless dad, that is, put a tube to channel the urine from his extended bladder and how this led to an ‘oceanic’ release. Just passing urine can, in Gawande’s prose, be as liberating as finding moksha in the spiritual sense. And this is what is so reassuring. Gawande allows us to make friends with the enemy that might be lurking at this very moment in each one of us.
Gawande’s quest, however, is much more serious. He tracks the end-of-life options available to individuals, as they navigate the long stretch from a productive life to retirement, the loss of a life partner and eventual abandonment by the nuclear family that the increased lifespan has made almost the norm now. Because he makes us care for the people he describes, they become not just statistics, but real people. These are often persons he can call family and this intimacy allows us to feel their anguish, as they make their often agonising decisions.
In the US, the options are many, from old-age shelters and retirement homes mandated by the government to communities for assisted living and various degrees of nursing and care to apparently idyllic villages for the elderly run like ‘star’ hotels. Families can actually shop for these facilities. In most cases described by Gawande, elder parents also have a say in where they spend the rest of their lives.
For the Indian reader, these propositions are, of course, interesting. We are now at the cusp of moving away from the old joint family system, where the question of looking after an elderly person was part of the cultural blanket. Gawande includes a description of the last years of his grandfather, Sitaram Gawande, who was from a tiny agricultural community in Maharashtra. His grandfather lived till he was 110 years old, triumphing over many vicissitudes—not the least outliving three wives—but managed to be chipper right till the end when he fell off a local bus and knocked his by then fragile head.
Gawande’s underlying message appears to be that we need to be in control of our mortality, even in extremis. Or, to paraphrase the poet, “To Die. Perchance to dream. Don’t stint on the morphine!”
Geeta Doctor is a
Being Mortal: Medicine and What Matters in the End