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Being Mortal: Medicine and What Matters in the End

de Atul Gawande

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5,3412842,012 (4.46)553
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.… (mais)
  1. 20
    Final Exam: A Surgeon's Reflections on Mortality de Pauline W. Chen (BookshelfMonstrosity)
    BookshelfMonstrosity: Written by experienced and dedicated physicians, these compelling books question American health care's emphasis on management and technique to the detriment of human relationships between doctors and patients, especially when the patient's mortality is an important consideration.… (mais)
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Mostrando 1-5 de 291 (seguinte | mostrar todas)
Overview:
The medical profession is generally trained to resolve problems, to fix problems. But age is a normal function that continuously makes life more difficult. Age cannot be fixed. The medical profession can patch the body, but always temporarily and usually with other consequences. Even if a person does everything right, they will still accumulates problem and end with death. Making more correct health choices over a life time can reduce the chances of many age-related symptoms, but death cannot be overcome. Not thinking about the aging process, prevents individuals from adapting to the differences. Only by accepting the fragility of life, can an individual change to make the aging experience better.

The problems of age are a recent human phenomenon. Historically, old age was rare, as people did not survive to experience the ravages of age. Medicine made many previously fatal events, not mortally threatening, therefore prolonging life. Medicine has even slowed down many mortal threats. Slowed down their progression, but not cure them. Death is still the final outcome. There are those who do not fear death, but fear what happens before death. The loss of function, and friends. Perspective changes when primed by age. Perspective that reorients priorities away from vanities, power, and achievements, and towards appreciating everyday pleasures, and connecting with others.

As people age, they become more dependent on others, but they do still want to live at home and be independent. Nursing homes tend to relieve family members of the burden of taking care of the elderly, not of making life worth living for those people. There are facilities that enable elders to live as well as they can, by bringing to them things that make life worth living.

For the elderly, choosing freedom does not mean that health is sacrificed. Research showed that those who had more independence, had better physical, cognitive, and mental health. Better outcomes, at lower costs.

There are people, are can be very active in old age. But that is a rarity. Biological luck. Making everyone else feel like a failure. Distracting everyone else from adapting to their situations. For most, the fragile body will continue to weaken.

Caveats?
This is a very emotionally jarring book. The reader must come prepared emotionally to handle the topic. Without even much prompting, the book forces the reader to reflect on one’s own life. One’s own mortality. One’s own inevitabilities. This reflection, the acknowledged finite time of one’s life, can make individual’s change the choices that they make.

This book uses many examples to highlight the problems with how the society deals with aging. Sometimes, the author gets lost in the examples, which distracts from the problem that needs correcting. ( )
  Eugene_Kernes | Jun 4, 2024 |
"Being Mortal to me reminds me that life is short and we must live life according to our own ancient lifestyle habits and not the modern habits. To me that means taking care of my body by exercising daily in different formats, eating healthy foods, enjoying nature and its simple beauties and spending time with family and loved ones through conversations over the phone and in person. it also taught me that your tribe that you make your family is everything to keep you going when you are older to sustain you so that you can live on your own with minimal support."

"Coming form a background wherein the elderly are not placed in a nursing home once they reach ancient years but are taken in by younger relatives and cared for until they pass away it means that family unity is important to my familial clan and to my natal family-my parents-as well. My siblings see it differently though I won't get into that here in this review. I also see caring for my parents not as my duty, but as my obligation to pay it forward and to bless them in their aging years and give them an excellent quality of life just as they gave me a great start to life!"

"I will always treasure this book for reminding me that living with my parents until they die and caring for them out of love and joy is better than moving out and being miserable to pay someone else's mortgage and let them live debt free and have a better quality of life whilst your parents suffer in their lives. From the example the author gave about his relatives it inspired me to stay the course and continue serving my parents faithfully in their home and do my part to make their lives easier as they age by being as supportive of their independence and wishes as much as possible and for them to respect mine as well. But for us to also collaborate together as a team to come. up with a game plan for their enjoyment and happiness without spending any money. For me that is spending time reading with my mother. For my father and I ti is deep conversations that give me insights and a window into his heart and peace in knowing that he is going to be okay even though he may never be reconciled with certain family members for various reasons. I see it as my duty and my charge to bolster my parents and to champion my siblings separately and promote unity and harmony for all my living relatives that I am in contact with so that being mortal in this life of living will turn into a beautiful eternity of a lasting legacy of joy, harmony, wisdom, and peace at the end of our days. That is what this book taught me." ( )
  Kaianna.Isaure | May 29, 2024 |
An excellent look at the end of life in its many forms, focused on old age but including terminal illness at all ages. Hospice and palliative care are so important but they are often put off in hopes of finding a cure for what may not have one. I think this would have been better with some mention of the disparities between care offered to those in different socioeconomic classes. This was still very good though, especially with the focus on accepting our own mortality. ( )
  KallieGrace | May 8, 2024 |
This book should be required reading for anyone with aging parents. Who am I kidding? Everyone needs to read this because all of us will face these decisions someday for ourselves or for someone we love.

The book talks about death with dignity. What makes life worth living when your body is at the edge of failure? How much medicine is too much? How can we do the right thing to make care for the elderly better in assisted living homes?

I read this book a week after my Mother passed away. I feel comforted by the book because it supports the decisions that were made at the very end of her life but it makes me feel terrible about my own lack of interest in her life while she was living in assisted living.

Very readable despite the subject matter. ( )
  hmonkeyreads | Jan 25, 2024 |
An important book, but gut wrenching to read. I wonder how many important conversations with loved ones will be started by people who read it. How much are you willing to suffer now for a chance at more time? How do you choose between options that are all terrifying? Who can you count on to decide for you when you can't decide for yourself? I hope all med students read it. One of the few light moments for me was how much doctors don't want to treat "Old Crocks" as we oldsters are known. I'm going to make a real effort not to seem vague and cranky next time I talk to a physician. ( )
  dhenn31 | Jan 24, 2024 |
Mostrando 1-5 de 291 (seguinte | mostrar todas)
His new book, “Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death.

It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.”
adicionado por melmore | editarNew York Times, Sheri Fink (Nov 6, 2014)
 

» Adicionar outros autores (8 possíveis)

Nome do autorFunçãoTipo de autorObra?Status
Gawande, Atulautor principaltodas as ediçõesconfirmado
Petkoff, RobertNarradorautor secundárioalgumas ediçõesconfirmado
Pradera, AlejandroTradutorautor secundárioalgumas ediçõesconfirmado
Röckel, SusanneÜbersetzerautor secundárioalgumas ediçõesconfirmado
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I see it now—this world is swiftly passing.
—the warrior Karna, in the Mahabharata

They come to rest at any kerb:
All streets in time are visited.
—Philip Larkin, "Ambulances"
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I learned about a lot of things in medical school, but mortality wasn't one of them.
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Modern scientific capability has profoundly altered the course of human life. People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical profession have proved alarmingly unprepared for it.
In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussions were an experimental drug, the FDA would approve it.
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don't want a general who fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can't, someone who understands that the damage is greatest if all you do is battle to the bitter end.
… our driving motivations in life, instead of remaining constant, change hugely over time and in ways that don’t quite fit Maslow’s classic hierarchy. In young adulthood, people seek a life of growth and self-fulfillment, just as Maslow suggested. Growing up involves opening outward. We search out new experiences, wider social connections, and ways of putting our stamp on the world. When people reach the latter part of adulthood, however, their priorities change markedly. Most reduce the amount of time they spend pursuing achievement and social networks. They narrow in. Given the choice, young people prefer meeting new people to spending time with, say, a sibling; old people prefer the opposite. Studies find that as people grow older they interact with fewer people and concentrate more on spending time with family and established friends. They focus on being rather than doing and on the present more than the future.
Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.
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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.

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