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Hospitals represent both the great advantages and limitations of modern medicine. Initially, hospitals primarily helped poor people gain some comfort as they died—most doctors treated people in their own homes. But after World War II (with improvements in antibiotics, surgery, and other treatments), hospitals transformed from symbols of sickness and death to places of hope and healing, reflecting the new benefits of modern medicine. Yet at the same time, hospitals have also become symbols of its limitations. Many people who have severe conditions or incurable diseases, including Joseph Lazaroff and Sara Monopoli, tell family and friends that they don’t want to die in the hospital. But because both doctors and patients constantly consider additional treatments that have a scant possibility of helping patients live longer, patients continue to receive more and more treatments and surgeries at the hospitals. These treatments can often lead patients to a kind of death that they do not want, as Lazaroff and Monopoli both die in the hospital due to complications from treatments.
In these cases, hospitals symbolize some of the problems with over-medicalizing death: because the medical system doesn’t prioritize well-being over lifespan, people spend their last days in this sterile hospital environment, barely conscious and intubated or on ventilators, rather than having meaningful goodbyes with family. While hospitals do often allow people to live longer, they also ultimately reveal that medicine does not always cure or save people, and society has to be willing to acknowledge these limits.
Hospital Quotes in Being Mortal
The Being Mortal quotes below all refer to the symbol of Hospital. For each quote, you can also see the other characters and themes related to it (each theme is indicated by its own dot and icon, like this one:
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Chapter 3
Quotes
But hospitals couldn’t solve the debilities of chronic illness and advancing age, and they began to fill up with people who had nowhere to go. The hospitals lobbied the government for help, and in 1954 lawmakers provided funding to enable them to build separate custodial units for patients needing an extended period of “recovery.” That was the beginning of the modern nursing home. They were never created to help people facing dependency in old age. They were created to clear out hospital beds—which is why they were called “nursing” homes.
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This is the consequence of a society that faces the final phase of the human life cycle by trying not to think about it. We end up with institutions that address any number of societal goals—from freeing up hospital beds to taking burdens off families’ hands to coping with poverty among the elderly—but never the goal that matters to the people who reside in them: how to make life worth living when we’re weak and frail and can’t fend for ourselves anymore.
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Chapter 5
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The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns. It’s been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs.
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Chapter 6
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It’s worth pausing to consider what had just happened. Step by step, Sara ended up on a fourth round of chemotherapy, one with a minuscule likelihood of altering the course of her disease and a great likelihood of causing debilitating side effects. An opportunity to prepare for the inevitable was forgone. And it all happened because of an assuredly normal circumstance: a patient and family unready to confront the reality of her disease.
I asked Marcoux what he hopes to accomplish for terminal lung cancer patients when they first come to see him. “I’m thinking, can I get them a pretty good year or two out of this?” he said. “Those are my expectations. For me, the long tail for a patient like her is three to four years.” But this is not what people want to hear. “They’re thinking ten to twenty years. You hear that time and time again. And I’d be the same way if I were in their shoes.”
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Epilogue
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If to be human is to be limited, then the role of caring professions and institutions—from surgeons to nursing homes—ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we 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.
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Get the entire Being Mortal LitChart as a printable PDF.
Hospital Symbol Timeline in Being Mortal
The timeline below shows where the symbol Hospital appears in Being Mortal. The colored dots and icons indicate which themes are associated with that appearance.
Introduction
...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...
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Chapter 2
...Even if doctors can’t stave off damage, they can stave off death. When people enter hospitals looking terrible, doctors can provide them with care that allows them to recover some ground....
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One morning, Gawande sits in on some patient visits in the geriatric clinic in his hospital with the chief geriatrician, Juergen Bludau. The doctor’s first patient, an 85-year-old woman named Jean...
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Chapter 3
...casts come off, she collapses at lunch. An ambulance comes to take her to the hospital, and she dies on the way there. When Gawande sees Felix three months later, he...
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...time, if a person were ill, doctors mostly tended to them in their own bed. Hospitals were mainly custodial, providing warmth, shelter, food, and care from nurses, but they did little...
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At hospitals, people gave over nearly every part of their lives to doctors and nurses in exchange...
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...would only pay for care in facilities that met basic health and safety standards. Many hospitals couldn’t meet those standards, and so the Bureau of Health Insurance dictated that if a...
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...needed help with all her daily activities. Her privacy and control were gone. She wore hospital clothes most of the time and stuck to a schedule of eating and bathing dictated...
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...the final phase of life by not thinking about it. Institutions address goals like easing hospital beds or unburdening families, but they do not address the goals of the people inside...
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Chapter 4
Bored in the hospital, Carstensen started taking an introduction to psychology class with the help of her father, who...
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Chapter 5
...New Berlin, New York. Until then Thomas worked as an emergency physician at a nearby hospital, and he took the job as a chance to do something different. With fresh eyes,...
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...a low-income housing unit. Carson often battles the medical system, working with ambulance services and hospitals so that the place is consulted about care for residents. But to her, it’s most...
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...normally unheard of in nursing homes. It also looks like a home, rather than a hospital. This is in part thanks to Bill Thomas, who wanted to build a home for...
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Chapter 6
...to drain fluid that interferes with her breathing. Three weeks later, Sara returns to the hospital with a pulmonary embolism and starts on blood thinners. But then doctors discover that she...
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Gawande speaks with an intensive care unit physician in his hospital. The physician says that of the 10 patients in her unit, only 2 are likely...
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...several occasions, she tells her family that she does not want to die in the hospital. But she avoids the prospect that the time might be coming soon and she pursues...
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...trouble breathing. Rich has no hospice number to call, so he dials 911. At the hospital, Sara is diagnosed with pneumonia. They give her intravenous antibiotics and high-flow oxygen. She begins...
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...jumped from 26% to 70%. Surprisingly, patients visited emergency rooms half as often and used hospitals and ICUs more than two-thirds less. Overall costs fell by almost a quarter.
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In La Crosse, Wisconsin, elderly residents have unusually low end-of-life hospital costs and an average lifespan of more than a year longer than the national average....
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Block’s 74-year-old father Jack was admitted to a hospital 10 years earlier with a mass growing in the spinal cord of his neck. The...
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...to write two books. Eventually, though, he had too much difficulty swallowing. He cycled through hospitals and rehabs until he decided to start hospice care. He died five days later.
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...family and told them that she did not want to spend her dying days in hospitals or ICUs, but she didn’t know how to achieve that goal. That’s when her primary...
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Chapter 7
...say that most people with terminal illness in their countries would not go to the hospital, and the health system wouldn’t have money for it. But their stories still sound familiar:...
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...health care systems when they are ill. At the end of life, they die in hospitals. In the third stage, when a country’s income climbs to the highest level, people become...
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...They decide to see two experienced neurosurgeons: one at Cleveland Clinic, and one at Gawande’s hospital in Boston.
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...be gentle, and she was glad they spoke. The day after her discharge from the hospital, she was readmitted for more vomiting. This second episode also subsided quickly, but it helped...
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Chapter 8
...Ohio, he gets a late-night page that Jewel Douglass is vomiting once more. In the hospital, he finds that her cancer has grown and multiplied, and her abdomen fills with fluid....
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That same night, however, Douglass comes back to the hospital, as her vomiting returned. Surgery is now the best course of action to restore her...
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...soon, but she fears more pain, losing bodily control, and being unable to leave the hospital. Gawande knows that some in her position, offered death with dignity, might have taken it...
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...father isn’t waking up after taking a strong dose of pain medications. She calls the hospital, not the hospice agency, and they bring him to the emergency room. He has pneumonia...
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...that afternoon, Gawande’s father wakes up. He grows alert and unhappy about being in the hospital in deep pain—they fear he will lose consciousness again on the pain medications. But due...
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