Being Mortal gets even better when you get to the second half, when the focus shifts from nursing homes to actually dying. Reading between the lines, Gawande's has two important lessons for how to have a successful death.
1. Don't let the doctors anywhere near you.
Gawande sites a study where the researcher asked the doctors caring for five hundred terminally ill patients to estimate how long those patients would live and then followed those patients. Seventeen percent underestimated how long their patient would survive, while sixty-three percent overestimated. And the average estimate was five times what reality turned out to be. So when the doctor tells you that you've got a year to live, there's a fairly high likelihood that you won't make it three months.
More important, Gawande tells stories of patients and families who finally come to grips with the fact that they aren't going survive their condition only to have doctors come in and convince them to try one more thing -- intubation, surgery, whatever -- only to have that "one more thing" not only fail to add to the quantity of their life, but to seriously undermine its quality.
As Gawande puts it, "We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets -- and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win." Based on the stories he tells, doctors aren't all that willing to concede the ticket's a loser either.
2. Get real with your family members.
Gawande tells the terrible story of thirty-year-old woman diagnosed with lung cancer while pregnant. She has her baby and then descends into the seven layers of hell of contemporary cancer treatment -- round after round of chemotherapies that don't work, At every turn, decisions were made favoring long-shot faraway cures for the quality of life. Only in her final days does her family finally realize the benefits of palliative care on the patient and tell the doctors to stop inflicting her with more pain and suffering in the absurd hope of extending her life.
Compared to some of the other stories he tells of patients who are able to come to grips with the fact that their dying, and identify how they want their final days to be, it's pretty clear which is the better option.
In fact, Gawande sites a number of studies that show that talking about how you want to go, and taking advantage of hospice and palliative care, can actually extend your life. As the author puts it, for terminal patients "you live longer only when you stop trying to live longer."
As Gawande puts it, the secret to aging and dying successfully is to have two kinds of courage: "the courage to seek out the truth of what is to be feared and what is to be hoped.... [and] the courage to act on the truth we find."
It sounds good in theory. But the first problem we patients face is getting to that truth. In Gawande's story of the new mother with lung cancer, and no point does any doctor actually come out and tell her she's going to die. When even your doctors don't want to confront the truth, is it really all that reasonable to expect the patient or their family to do so?
