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BJS Bookshelf: Being Mortal – Illness, medicine and what matters in the end.

Authors: Recommendation and article by Nadia Henriksen; Staff Specialist, MD, PhD, FEBS-AWS, Ass Professor. Herlev Hospital, University of Copenhagen; Denmark; @DrHenriksen

Atul Gawande is an American surgeon, writer, and public health researcher. Being Mortal is about the inevitable process of aging and dying, which are hard subjects to face, but Gawande is an imminent storyteller, who takes the reader through an important journey with the use of personal experience, facts, and patient stories.

The first part of the book is about being old and the natural process of aging. Gawande discusses the importance of maintaining independence and freedom in the elderly population thereby giving them a purpose for living. There are ways to improve nursing homes using alternative designs such as including pets and children.

The second half of the book is not only about death in the elderly population but also in younger people with severe illnesses. Talking about death is difficult for most doctors; however, Gawande guides the reader through the hard conversations. Lastly, Gawande addresses bravery and courage, which are needed for both doctor and patient to accept being mortal.

As surgeons, our mindset is set on fixing what is broken. Facing elderly or terminally ill patients with a surgical problem may be challenging, as the surgical condition itself may be fixable, but the patient’s overall condition may not be improved by surgery. Doctors are often prone to go on with a treatment. Scheduling the patient for surgery may be easier than having the hard conversation.

In ‘Being Mortal’ Atul Gawande gives useful and simple tools that are helpful in the conversation with the patient. It is important to take the time for the conversation and to express the realness of the situation. Instead of giving a load of information, a doctor should ask questions to understand the patient’s wishes, then inform and then ask questions again. Some patients are better off without complicated surgery and simply want a temporary fix to see them through a few of life’s final pleasures.

Death is an unsavory subject – people including doctors don’t like to talk about it, probably because death is feared by many. Doctors overestimate time left when talking to dying patients, and tend to move the conversation to hope rather than death. It takes courage as a doctor to have the hard conversation with a patient – courage to face your own mortality.

Every surgeon will meet dying patients and will have to face the hard conversation. We are all going to die and yet we have difficulty accepting it. Being Mortal is a helpful guide in the right direction and is therefore a must-read for every surgeon.


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