BEING MORTAL: Medicine and What Matters Most in the End.
BEING MORTAL: Medicine and What Matters Most in the End. By Atul Gawande. NewYork: Metropolitan Books, 2014. 282 pages. Hardcover. $26.00.
Atul Gawande is not a theologian. He is, by profession, a medical surgeon, author, and professor at Harvard Medical School. He is also a son, husband, and father, which are no less important to the insights and wisdom that he offers in this book. This book is not a theology, but, by-and- large, its contents do not conflict with orthodox Lutheran theology, thus making it a worthwhile read. On page nine of the introduction to his book Gawande states, “This is a book about the modern experience of mortality—about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong.”
This introductory statement is accurate, and thus it’s not surprising to find that Gawande spends a significant portion of his book speaking about gerontology, independent living, family dynamics, sociological factors, medicinal interventions, and the conversations that should take place as one inevitably progresses toward their death.
Without realizing it, Atul Gawande speaks like a theologian of the cross. He doesn’t call a good thing bad and a bad thing good. He scoffs at the naïve optimism of aging reflected in the titles of books on that very subject (e.g., Younger Next Year or Ageless), and warns that unwillingness to truly address the reality of our mortality is, “blind[ing] ourselves to the opportunities that exist to change the individual experience of aging for the better” (p. 35). He talks (unbeknownst to him) like St. Paul who speaks of creation being in “bondage to corruption” (Rom 8:21).
Gawande weaves stories of individuals who must confront the reality of their mortality in significant ways. Whether it’s “Felix” caring for his elderly wife, or “Alice” dreading the moment when her health would force her to leave her home for a nursing home or healthcare facility, or “Sara,” a 34-year- old woman thirty-nine weeks pregnant with her first child who was unexpectedly diagnosed with terminal lung cancer. These stories are told with sympathy and respect to their situations. As the reader, you grapple with their mortality along with these characters. You read of how they dealt with these problems. Some stories and choices are encouraging, others are heart-breaking and horrifying, but through these stories—injected with summaries of pertinent published medical studies—you begin to get a picture of how one might handle a similar situation with more clarity and purpose.
One of the most masterful contributions of this book is Gawande’s ability to caution his readers against the false hope that medicine provides. Medicine cannot stop your mortality, but that hasn’t stopped it from making a mess of dying. Gawande writes of a time when he was asked of a patient by her sister, “Is she dying?” To this Gawande writes, “I didn’t know how to answer the question. I wasn’t even sure what the word ‘dying’ meant anymore. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality and created a new difficulty for mankind: how to die” (p. 157–58).
As Christians, we know that immortality is only found in Christ Jesus. So what role should medicine play in extending our life or delaying our death? These are the questions Gawande helps us answer. On page 161 he provides a good compare/contrast between ordinary medicine and hospice care. Beginning on page 173 he discusses the costs associated with extraordinary care for terminal patients. And on pages 177–78 Gawande drops the biggest bombshell of them all: the result of a study of 151 people diagnosed with stage IV lung cancer.
Half were provided with typical oncology care, the other half received oncology care in conjunction with regular visits from palliative care specialists. The result was that those who consulted a palliative care specialist stopped chemotherapy sooner and entered hospice care far earlier. Though it seems counter-intuitive, those who did so not only experienced less suffering, but, on average, lived twenty-five per cent longer. “In other words,” Gawande writes, “our decision making in medicine has failed so spectacularly that we have reached the part of actively inflicting harm on patients rather than confronting the subject of mortality” (p. 178).
In the end, Gawande makes a most profound statement that could very well be the conclusion lifted straight from the pages of Holy Scripture, “There is no prettifying death” (p. 189). Gawande leaves the door open to the only hope we have in the face of death: Jesus Christ. Gawande, of course, doesn’t take you there, but having summarily established the parameters of medicine’s reach and effect, there’s nowhere else for the Christian reader of the book to turn.
Who should read this book? I recommend that if you suspect that you or someone you love may one day die, then this is a book you ought to read. If the wisdom of this book is supplemented with adequate spiritual care from a pastor, there is no tallying the blessings that will result.
St. Paul writes to Timothy that our Savior Jesus Christ “abolished death and brought life and immortality to light through the gospel” (2 Tim 1:10). Because of sin though, on this side of the resurrection of all flesh, mortality is something we must face and Atul Gawande helps us think about that subject matter in an exceptionally clear and wise way.
Rev. Timothy A. Koch, Pastor of Concordia/Immanuel in Cresbard/Wecota.