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Being Mortal: Medicine and What Matters in the End

Being Mortal: Medicine and What Matters in the End

Escrito por Atul Gawande

Narrado por Robert Petkoff


Being Mortal: Medicine and What Matters in the End

Escrito por Atul Gawande

Narrado por Robert Petkoff

valoraciones:
4.5/5 (325 valoraciones)
Longitud:
9 horas
Editorial:
Publicado:
Oct 7, 2014
ISBN:
9781427244246
Formato:
Audiolibro

Descripción

In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

A Macmillan Audio production.

Editorial:
Publicado:
Oct 7, 2014
ISBN:
9781427244246
Formato:
Audiolibro

Sobre el autor

Atul Gawande is the author of four bestselling books: Complications, a finalist for the National Book Award; Better; The Checklist Manifesto, and Being Mortal. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Founder and Chair of Ariadne Labs, a joint center for health systems innovation, and Lifebox, a nonprofit organization making surgery safer globally. He is also chair of Haven, where he was CEO from 2018-2020. He and his wife have three children and live in Newton, Massachusetts.


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  • Take a step back from the battle over universal healthcare to get a larger overview of the price of living longer thanks to better technology and treatments. Surgeon Atul Gawande focuses specifically on end-of-life care. "He's a fantastic writer, and this book is written with a combination of humility, the ability to admit to failure, and he weaves in the science effortlessly throughout," writes Michael Mosley for The Guardian.

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Reseñas de lectores

  • (5/5)
    this is a must-read!
  • (5/5)
    Once again Atul Gawande does not disappoint. How fortunate we are to have an eloquent, brilliant and empathetic MD (surgeon, in fact) who writes about the big questions facing modern medicine. This book looks at how we deal with the elderly & people with terminal illnesses.

    The first part, which reviews the current status quo of elder-care, is fairly depressing but as soon as Gawande starts describing some of the new approaches things do a 180°. The times are a'changing'.

    The latter part of the book delves into the end of life. He looks at the decisions people face as the end nears and realizes that to help patients, doctors need to be trained to deal with death. Fortunately, there is a successful model to follow, and that is the hospice/palliative care treatment approach.

    In a nutshell. "We've been wrong about what our job is in medicine...(snip)...Whenever serious sickness or injury strikes and your mind or body breaks down,the vital questions are the same: What is your understanding of the situation and it's potential outcomes? 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? "
  • (4/5)
    A must-read for anyone with aging parents.
  • (4/5)
    The author, a general surgeon, has spent his professional career trying to do what he was taught: fix his patients physically. Quantity of alternatives, not necessarily quality of life. It was assumed that longevity was worth any inconvenience and pain. A few years ago he began researching end-of-life care options with the goal of improving the lives of his elderly and end-stage patients. He consulted patients, geriatricians, pioneers in independent care programs, and hospice organizations, and provides the reader with a look at traditional nursing homes (and their history), home care and institutional alternatives, and trade-offs made by patients and families. His own father's illness and death provided him with a chance to put to use some of the techniques he'd learned. The nursing home chapters describe typical (and nightmarish) conditions, and it was all I could do to continue. But once the book turned to the alternatives being developed, I found myself less traumatized thinking of my own future. While traditional medical care might stress the goal of prolonging lives, this often leads to situations that are the opposite of what patients really want, which is, typically: avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. (These issues become priorities not only to old people but to younger people who find themselves facing illness and end-stage disease.) In nursing homes, where the emphasis is on keeping patients physically safe, patients can feel imprisoned, without privacy or the right to make decisions about how to spend their time and with whom.Doctors are traditionally trained to offer fixes, including those which are more and more experimental or unlikely to help. They are not taught to suggest there might be more meaningful alternatives, and sometimes the end of treatment. The author learned to ask very ill patients several questions, which even he, with all his new knowledge and desire to improve matters, found extremely difficult to do:At this moment in your life:1. What do you understand your prognosis to be?2. What are your concerns about what lies ahead?3. What kinds of trade-offs are you willing to make? How much are you willing to go through to have a shot at being alive, and what level of being alive is tolerable to you?4. How do you want to send your time if your health worsens?5. Who do you want to make decisions if you can't?I was profoundly moved by the range of these questions and the responses they elicited. Clearly, patients aren't always thinking about the same things as other patients, or their families, or their health care workers. One striking result was that that families and doctors, finding themselves at a crisis moment in the patient's life, didn't have to make the hard decisions - the patients had already said what they wanted. An excellent overview of possibilities for anyone concerned with these issues.
  • (4/5)
    You have to read it
  • (5/5)
    This book made me cry several times; contemplating one's own aging and mortality, and having Gawande narrate the end-of-life stories of his patients and his own father, was sobering and thought provoking
  • (5/5)
    “A colleague once told her, Wilson said, ‘We want autonomy for ourselves and safety for those we love.’ That remains the main problem and paradox for the frail.”

    The above quote sums up beautifully much of what Dr. Gawande discusses in this really lovely, interesting and motivating book. Being Mortal focuses on how modern medicine has failed us in that it can keep people alive much longer than it used to, but often at a very serious cost. His focus is primarily on the elderly, but he also includes the seriously, terminally ill in this exploration.

    Think about the above quote. We all want to do what we want – to have the freedom to decide when we will get up in the morning, what we will eat, and who we will spend time with. But, when it comes to our loved ones, it seems that so often what we most want is for them to be safe. It is that concern that has led us to do things like put people into nursing homes to keep them safe from falls, even though they are much more miserable. As long as they are safe, that’s all that matters. But Dr. Gawande makes the very compelling argument that the safety isn’t the primary concern, or shouldn’t be. Allowing people to live meaningful lives, whatever the person’s own definition, should be our concern as people age or experience the end stages of a terminal illness.

    The book does a great job of illustrating how doctors really shy away from having the frank conversations with their seriously ill patients. They provide information, but that information is often based on what to do to lengthen life, not improve the quality of it. Taking a page from the palliative care / hospice movement, Dr. Gawande advocates for asking the hard questions, like what do the patients fear most, what is the quality of life they’d be willing to tolerate, and similar questions, to really get at the heart of their concern.

    Dr. Gawande also looks at how, especially with the elderly, we focus too much on keeping them safe as opposed to happy. He provides the back story on the nation’s first true assisted living facility, where residents were allowed to do things like lock their doors. Yes, they might fall, but the staff was dedicated to providing whatever support services were necessary to allow these residents to keep as much independence as possible. It is amazing when you really think about how much we focus on things like fall prevention (which is important, obviously), but not on really figuring out ways to prevent the falls WHILE allowing people access to the things in their lives that matter, like deciding when to get out of bed in the morning.

    I strongly recommend this book, especially for those who have parents who are elderly, or for those who care about the quality of life of seriously ill people. It asks us to reframe our thinking, and really consider what it is that we value, and how we would want others to take that into consideration as we got older or sicker.

    And with that, I complete my second Cannonball Read. I’ve put together a wrap-up post over on my own blog:
  • (4/5)
    This book seemed to be basically a plea for more doctors to be better trained in gerontology and participate in managing the health & well-being of old people. It's certainly valuable to point out that the objectives of managing the health of a 90 year old are not the same as the objectives of managing a 30 year old's health. Medical heroism and high tech solutions are not usually required. However, the reality is that resources are not going to come in sufficient quantity to rescue the quality of life of most old people. Unless we die suddenly we're destined to spend our final years in miserable nursing homes. I decided not to finish reading this as It was too depressing to read about my future as an aged and disabled person. Maybe I'll be lucky enough to be one of those who die suddenly while doing whatever it is they enjoy most (reading a book?)
  • (5/5)
    Malcolm Gladwell mentioned the author in an interview and my doctor daughter confirmed that it would be a good book to read, as indeed it was. Although a surgeon, the author has been able to write about complex medical issues so that a layman can understand. The subject is made more poignant by the author's personal experience with the death of his father. It could be the most important book that any of us could read.
  • (5/5)
    The book is very well written. It is touching with the message delivered using very interesting stories from the author's experience. Basically the book is about medicine as a means of well-being and not simply keeping people alive. It covers care of those who are aging and meeting their needs for a life worth living and not merely a place of safety. There is much on the improvements coming to assisted living and nursing homes. It covers treating life-threatening diseases and the question of how far to go in this endeavor; what is it that a person is willing to go through and what is it that they need for life to have meaning in their condition. How does a doctor fit into the process of deciding what should be done? There are not easy, pat answers in the book, but it does give much food for thought about difficult questions and it does it in a gentle yet reality-based way.
  • (3/5)
    This genre is so hot right now. But I appreciate any work done to forward the idea of a positive death we can get. Thinking about death in the abstract is easy, but really there can't be any knowledge gained until you go through a death yourself.
  • (4/5)
    This book is a great help. If someone is having a family member that is sick it allows you to understand more the importance of the quality of life and the dignity of the person in it's last months, it also help you to learn how to let go. I really like it the way is written the use of multiple stories to make us see what really matters at the end.
    The only think that I do not like that much is that is focus in US (The author is from US so I guess I can't ask for less) but it alw us to learn in a beautiful way that sometimes we have to take choises that does not seem so easy but they can work for the best.
  • (4/5)
    This is the third book that I have read by this author, and I will certainly look forward to anything he writes in the future. He always offers a clarity and intelligence to everything he presents. This is perhaps his most personal work. In fact, this is really two books in one. The overall theme of the book is about how the health care industry handles the aged and dying. The author summarizes his focus well: "We've been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being." The first half of the book concentrates on how our rapidly increasing senior population is offered poorly matched services, some of which actually hurt more than help. It presents examples of significant improvements that have failed to be promoted well, in great measure because the profit motives are elsewhere. The second half of the book is much more personal and about end-of-life measures, primarily for oncology patients, but which could apply to almost anyone. While both parts of the book fit under his theme, it is not unreasonable to think this could have been two standalone books fleshed out even more. He makes a great case for meaningful work in this area, regardless. Well worth reading for anyone facing their senior years or anticipating future involvement with someone who is.
  • (4/5)
    A very good eye opening book.
  • (5/5)
    This is a book that everyone should read. All of us will die and most, if not all, of us know someone who if not far from the end. This volume offers concrete guidance on how to die well according to specific wishes and goals of the dying. That includes ways of negotiating thru the medical options that may be possible but that may not improve either the quality or duration of remaining life. Having seen good and bad deaths, the advice is solid and helpful. Read this.
  • (5/5)
    Brilliant, informational, and honest. It is amazing that hearing that autonomy matters, often more than safety, in the treatment of our infirm elders is revolutionary, but for me it was. I never really thought about it with my own father. We needed him safe, that as our only concern. And from the day we put him in assisted living he did nothing but pray for death. There were many other things that led him in that direction, but that loss of autonomy was at the top of the list. And it seems so common sense. I have often said that I want the right to die if I lose the ability to take care of myself. But when it came to caring for my father I never gave it a moment's serious thought. Gawande is always exceptional, but with this book that combines research and reporting with the crushing and personal story of his own father's death and dying, he redefines the genre. A must read for everyone.
  • (5/5)
    This is a book about palliative care. But it's even more than that. It's about the choices people face at the last stages of life when confronted with terminal illness or very serious debilitation, and how it all can be helped - not to reverse the course of events (which is impossible) but to alleviate the torments to the utmost. Not a cheerful read at first, but it's frank... And the more I read, the less I felt depressed about aging and problems associated with it. NOT because, like in much of popular literature, old age is hyped up to be the grand renewal of sorts. The author says that "people naturally prefer to avoid the subject of their decrepitude... Still, there are costs to averting our eyes from realities..." Because then, "we blind ourselves to the opportunities that exist to change the individual experience of aging for the better". And that's what the author is trying to establish - the reality of aging and mortality, how to face it and how deal with it in the best way possible, with quality of life in mind, as opposed to just with extending the quantity of days, weeks - which, prevalently, is the goal in the medical field these days.Dr.Gawande describes nursing home concept (very failed experience in most cases, as he proves), assisted living (that originated so successfully in Oregon), and hospice at home that caters (if properly done) to each specific individual and is aimed at the quality of the ending phase of life. The doctors' job, he maintains, should not be just "to ensure health and survival", it should be "larger than that. It is to establish well-being. And well-being is about the reasons one wishes to be alive". It is even more poignant for the author - as he describes his own father's dying.In conclusion, Dr. Gawande says that "...whatever we (as doctors) can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking."I think everybody should read this book. The subtitle is "Medicine and What Matters in the End" - it pretty much says it all...
  • (5/5)
    Absolutely beautiful and heartbreaking book about modern medicine and how our medical profession deals with aging and dying today. Gawande is a surgeon in Boston struggling with how to deal with patients (and his father) who are terminally ill and trying to figure out what lengths to go to in order to stay alive.As Keynes said, "in the long run, we are all dead". Gawande lays out this point (though he doesn't quote Keynes)- sometimes doctors can "save" someone from imminent death, but death is still coming down the road- how do we want it to come?I needed two boxes of tissues for this one- he tells of a number of his patients and others in his life confronting these questions. Some of them end badly, some happily, but as in real life, nobody wins forever.
  • (5/5)
    I want to give a copy of this book to every caregiver I know, it moved me that much. This book gave me so much to think about, and I have a new mantra: one good day.
  • (5/5)
    Being Mortal is such an incredibly fantastic book. I highly recommend this for young, middle-age, and old people; for the healthy, those dealing with serious illness, and those caring for the aging and the sick. Absolutely everyone could benefit from this book. A common thing in Being Mortal is determining what matters most and striving to ensure you keep that in sight. I consider Being Mortal to be one of those life-changing books. You won't be the same after reading it.
  • (5/5)
    Everyone over 60 should read this book.
  • (5/5)
    Gawande carefully examines the last years of our existence and persuasively argues for placing quality of life, i.e., living the life each of us chooses, over prolonging life with increasingly invasive (and perhaps futile) therapies. I particularly appreciated his careful review of the evolution of living arrangements for elderly people and his unflinching account of personal agony in dealing with tough questions with his patients and with his own parents.
  • (4/5)
    I finally got around to reading this widely-read and reviewed book. The subject matter is truly timely and important. I think I was expecting a book focused on medical powers of attorney, living wills, end of life discussions etc. These subjects were touched upon, but the book has a much broader intent. It stresses something I think I already subconsciously knew--that most older people want to live as independently as they can for as long as they can, and that many of our current nursing homes/assisted care living homes stifle the elderly's will to maintain their individuality and independence. There are movements afoot which interest me very much that enable our elders to live independently, but still be able to access assistance when they need it.The other major point of the book is that in our modern era the care of the elderly has become entirely too medicalized, and this is not a good thing. Rather, the goal should not be strictly to ensure survival, but to "enable well-being. And well-being is about the reasons one wishes to be alive." Every person will have a different definition of "well-being," and we need to start having discussions (and deciding for ourselves) what quality of life or well-being will make our own life worth living.Highly recommended.4 stars
  • (5/5)
    What an astounding and outstanding book.It deals with the realities of life, death, illness and suffering in such an accessible way. It considers what medicine can do - and what it should - and knowing the difference and how to choose. This book should be compulsory reading for everyone offering an opportunity to think about the difficult questions for yourself and those you love.
  • (5/5)
    Excellent perspective on living life as it nears its end.
  • (4/5)
    Something we don't like to think about, but need to.Having the hard conversation about quality of life, what do we want, what are we willing to sacrifice.
  • (4/5)
    I highly recommend this for any caregivers of terminally ill and/or elderly patients, as well as anyone living with elderly relatives.
    Gawande blends personal anecdotes with medical research to examine the issue of how our society today deals with mortality. All too often we are so concerned about the health and safety of our older generations that we forget that they should control the terms of their end of life as much as possible, and sometimes that means sacrificing medical treatment in the chance of having a more fulfilling life. I wish I had read this a few years ago when my own family was facing those hard choices.
  • (5/5)
    This is one of the most difficult books I have ever read. It is a frank look at end of the life issues and it is not an easy read, but it is a book that we should all take the time to look at. Gawande does a good job of going over the evolution of the assisted living and nursing home. He talks about how the medical "industry" is geared toward fighting death versus helping people deal with reality and make their remaining days quality ones. As we begin to move into a legal assisted death environment, we will all be able to have choices about how we want our life to end. For me it reinforced the importance of trying to stay as healthy as possible and realize that the quality of current days will probably be better than the future days and enjoy these days as much as possible. Again, not a happy book but worth the time.
  • (4/5)
    I wanted to read this because our Canadian Parliament recently passed legislation that legalizes assisted dying or MAID, medical assistance in death. Although the the author does address the topic, he believes that by providing hospice care in the home or in a facility, the desire for an assisted death would be significantly reduced.The author is a surgeon and the son of a surgeon. He began to question the idea of how people die in our society when his own in laws were faced with the health crisis of their mother and the services offered to the family were less than desirable.He traces the history of how the elderly were once cared for by their children in house to the current day where we put our parents in nursing or retirement homes for a variety of reasons. Since we are living so much longer than previous generations, the requirements for better and happier lives regardless of physical disabilities is central. He studies successful nursing/retirement homes which put patients first and also explores in detail the concept of in home hospice rather than hospital care for the dying. He questions the idea why medical science prolongs life through pharmaceuticals even though the the patient has a terminal disease that will kill them in a short time. These treatments often give false hope, cost insurance companies and government millions and cause pain and suffering to patients while prolonging the inevitable.He believes that we need to have difficult conversations with our families about what kind of death we wish to have before a medical crisis forces a less than careful or rational decision. He uses the stories of several individuals and their families to illustrate his concerns. His own father is one of his subjects.Well worth reading
  • (5/5)
    What matters in the end. Should be required for anyone in health care.