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Summary
Themes
Key
LitCharts assigns a color and icon to each theme in Being Mortal, which you can use to track the themes throughout the work.
Medicine, Survival, and Well-being
Safety vs. Autonomy
Destigmatizing Death and Illness
The Evolution of End-of-Life Care
Summary
Analysis
Dr. Atul Gawande recalls that, in medical school, he and his classmates rarely talked about mortality and how people experience death. The students and professors largely saw the purpose of medical school as teaching them how to save lives, not to tending to people’s demise.
Gawande opens Being Mortal—which is largely concerned with examining how people age and die—by showing how even students training to be doctors avoid the subjects of mortality and death.
Themes
The only time Gawande discussed mortality was in a weekly seminar called “Patient-Doctor,” in which they read Tolstoy’s The Death of Ivan Ilyich. In the story, Ilyich is 45 years old, and one day, he falls off a stepladder and develops a pain in his side. The pain grows worse, and he becomes unable to work. Doctors aren’t able to figure out exactly what’s wrong, and their remedies do nothing. Tolstoy writes that what bothers Ivan Ilyich the most is that everyone believes he is ill, not that he is dying. But he wants to be comforted as someone at the end of his life.
Ivan Ilyich’s example demonstrates the problem with many doctors’ mindsets. They frame almost everything as an illness, unwilling to acknowledge that people can and likely will die from certain conditions. As a result, Ivan Ilyich doesn’t receive the comfort he so desperately wants as a dying man—he doesn’t get to live out his final days in the way that he wants.
Themes
The medical students in the class believed that the failure in Ivan Ilyich’s case belonged to the doctors: they couldn’t properly diagnose him, and if they could, honesty and kindness and comfort would have followed. The students were more worried about having the proper knowledge, not about sympathizing. And yet when Gawande went out into the world, he found himself completely unprepared to help patients confront the possibility of death.
Even as students, doctors are unwilling to acknowledge their limitations, viewing it as their job to cure or treat a person, not help them grapple with it if medicine can’t save them. But as a result, Gawande felt that he had a knowledge gap in helping people understand their own mortality and confront their deaths.
Themes
Gawande flashes back to his time as a junior resident. At the time, he began writing essays, including one about Joseph Lazaroff—a city administrator in his 60s who is suffering from a metastatic prostate cancer. Lazaroff loses weight, his body fills with fluid, and one day he can’t control his right leg or bowels. The doctors find that his cancer has spread to his spine. It can’t be cured, but they hope it can be treated. They provide him with two options: comfort care or a relatively risky surgery.
Lazaroff’s story is typical, in that he is given a choice between traditional treatment and “comfort care,” likely meaning hospice care. Lazaroff chooses the surgery, but part of the problem is that he doesn’t fully understand the gravity of his situation or what the two options truly entail. This is because the doctors aren’t being fully clear about what the surgery will do for him and what its risks are—they simply want to try to fix his issues despite that this is highly improbable.
Themes
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No matter what, Lazaroff probably has a few months to live. Recovery would be difficult, and the operation could worsen and shorten his life. But Lazaroff still wants the operation. Lazaroff’s wife died on a ventilator in intensive care a few years earlier, and at the time he told his son he didn’t want anything like that to happen to him. But now he doesn’t want to feel like he is giving up.
Lazaroff’s belief that he is “giving up” plays into the common idea that people must fight death at any cost. But Gawande shows how this misconception comes at the risk of Lazaroff’s well-being. Death is natural, but because Lazaroff is unable to confront this fact, he makes a decision that goes against his desire not to die in the hospital on intensive care.
Themes
Gawande believes Lazaroff’s choice is a bad one, not because of the dangers of the operation, but because the operation cannot give Lazaroff the life that he really wants. The operation is a technical success, but Lazaroff never recovers from the procedure: he develops respiratory failure, an infection, and blood clots. Two weeks later, Gawande takes Lazaroff off the ventilator at Lazaroff’s son’s request.
Gawande introduces the idea that people often pursue the scant hope of survival or a better life at the expense of their well-being. And because Lazaroff didn’t fully comprehend that the operation couldn’t give him a better life, he wasn’t able to have closure or the kind of death that he wanted.
Themes
A decade later, reviewing the story, Gawande is amazed at how much the doctors avoided talking about the choice honestly. They explained the dangers of the treatment options, but they never communicated the reality of the disease: it could not be cured, and Lazaroff would never return to the life he used to have. In this way, they didn’t do much better (and may have done worse) than the doctors in Ivan Ilyich.
Gawande doesn’t shy away from blaming himself and the other doctors who were treating Lazaroff. While they did offer him choices, they didn’t give him actual guidance on what would give him the greatest well-being. Instead, they focused on what would give him hope for longer survival. Gawande regards this as a failure because it gave Lazaroff a misunderstanding of the reality of his disease. This emphasizes the need for honest discussions about death.
Themes
Modern science allows people to live longer and better than at any other time, but it also turns aging and dying into medical processes. In 1945, most deaths occurred in the home. But by the 1980s, only 17 percent did. The experience of aging and death has shifted to hospitals and nursing homes. When Gawande became a doctor, he did so to explore how medicine could pull people through difficult illnesses and injuries. He wasn’t prepared to see medicine’s limits.
Gawande touches on how progress in medicine has given people longer lifespans and better access to hospitals. But as a result, the process of dying has become extremely medicalized, and doctors—including Gawande—have a difficult time acknowledging that medicine has limitations.
Themes
Death is not a failure: death is normal and inevitable. It’s sometimes difficult for doctors to comprehend this, particularly because they are in a profession meant to fix problems. But with unfixable problems, doctors rarely know what to do, and this has caused “extraordinary suffering.”
Gawande emphasizes how death is normal, attempting to destigmatize it not only for readers and patients, but for doctors as well. Understanding that death is inevitable is crucial for doctors to fully grasp. That way, they can prioritize people’s well-being over the constant pursuit of treatments that may make their lives worse, as in Lazaroff’s case.
Themes
The book is about the modern experience of mortality in the United States, and how the current medical systems are failing. The last days of people’s lives are given over to treatments that addle their brains and sap their energies for the smallest hope of a benefit. They are spent in nursing homes, where people are cut off from all the things that mattered to them in life. Gawande aims to explore how the experience of dying has changed and how it might be improved.
Gawande explicitly states his aim here: to provide some historical context for the process of aging and dying, to critique medical institutions for how they prioritize survival over well-being, and to destigmatize death and provide a starting point for people’s own considerations of their final phase of life.
Themes
