|CURRICULUM IN CARDIOLOGY - BOOK REVIEW
|Year : 2017 | Volume
| Issue : 2 | Page : 120-121
Being mortal: Medicine and what matters in the end
Student, Delhi Public School, RK Puram, New Delhi, India
|Date of Web Publication||20-Nov-2017|
Student, Delhi Public School, RK Puram, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Seth U. Being mortal: Medicine and what matters in the end. J Pract Cardiovasc Sci 2017;3:120-1
Author : Atul Gawande
Language : English
Published by : Penguin Books India; Latest Edition (16 December 2015)
Price : INR 246
Pages : 296 pages
ISBN-10 : 0143425579
ISBN-13 : 978-0143425571
The stethoscope ever yearns to hear a heartbeat, the magically amplified dhak-dhak which denotes to the listener that life still gurgles through the body resting on the warm surgical table. The membrane is at ease, comforted by the heavy contractions and relaxations that it has become so well-acquainted with by now...
However, then suddenly, they fail. The pulses of sound wane, they slow, and finally ebb into silence...
The stethoscope finds itself helpless. It panics, for its purpose is now in question. It struggles and scrambles across the now-cooling flesh, desperate to transport any feeble heartbeat, any quivering inhalation, to the drooping ears of the doctor. However, there is nothing left to hear any more. It is lifted off the cold body and as it is coiled into a roll hears the words which denote its retirement for the day, “Time of death...”
But what next?
“Being Mortal,” the latest by well-known medical writer Atul Gawande, explores a curious theme, one that might appear to be taboo in the training years of a young practitioner but that has become so enormously vital in recent years that it cannot be ignored any further: ceding before death. Doctors spend a quarter of their lives trying to learn every possible tactic, technique, and strategy to snatch a dying patient from the jaws of death, to narrowly evade the greedy tentacles of an advancing disease and retrieve a patient to recuperation. They predict every possible outcome, foresee which misstep could send the patient spiralling, and then even preempt those last unlikely odds in fervent hopes to accomplish their mission and wheel the ailing patient out of the ward and back into a normal life. However Gawande now poses a perturbing predicament: so how is it, that in all these exhaustive eventualities, they failed to tackle the last and least desirable one of them all... death?
The author aims to explore the subject of mortality and its inevitable linkage with the medical profession, no matter how much it may try to evade it. It is the doctor's very job to heal a patient, to cure their various ailments, and restore their body to its fully functional state, but at what point must they give up? At what point must they accept the looming cloud of death and relinquish treatment?
This is a question that perhaps medicine as a whole has grappled with for a generation, but its pertinence has never been more than it is today. The theme that this novel unravels is the severe ineptness, of not only the medical profession but also humanity as a whole to face the prospect of mortality.
Through the ages, the one experiences that man has cowered before above all others, which drives brave-hearts from it rather than to it, that encircles every human being from the moment they have been born yet never touches it but once, is death. In a single fleeting moment, every single bodily function collapses in harmony and end. Then, there is nothing.
Yet, it's this fear of “nothing” that has driven humanity to conjure up the profession of medicine; doctors, the god-like superheroes who swoop in with a syringe and a prescription pad to drive away the black eagle hovering over your head. But what happens when they know they cannot drive the eagle away? When its approach is inevitable? Do they just... withdraw? Out of fear? Helplessness? Their work has failed, so what else is left to do? The patient must meet with the eagle themselves.
Except that they do not have to.
Does the ultimate journey that a patient has to make after months of treatment in a stifling hospital ward at the mercy of countless tubes, machines, and sterile fumes, need to be a lone one? Of course, it is not. However, history has repeatedly proven that doctors find themselves haplessly ill equipped when it comes to preparing a patient for the end they know is coming.
In his novel, the author recounts an evocative story by Tolstoy, in which the aged protagonist nears his end, yet nobody around him is ready to accept it. While he languishes on his bed and knows what is lying for him, the doctors and relatives around him are convinced that he is merely ill and not dying. However, this frustrates him - why cannot be pitied like a child? Why cannot he be mourned while he is alive? Why cannot he be allowed to die willingly?
Thus, Gawande arrives at one of the most prominent themes of his novel, of whether it is more peaceful for a person lying on his deathbed to continually be fed hopes of their survival till they draw their last breath, or be informed of the unavoidable outcome and accept the end when it comes. This quandary is perhaps most relevant to the modern-day health care of the elderly, to how doctors often stretch out every last strand of life from their sinews before allowing them to succumb to their ailments.
The acceptance of death, while a courageous decision on its own, is often necessary for the closure and long-standing solace of the family who is soon going to lose someone close to them. Moreover, the one who has to undergo the ordeal himself, he will brave it with infinitely more strength if he is at peace with it and knows that his loved ones are right by his side the entire way. Moreover, it all begins with the caregiver, the doctor, who must reveal the gut-wrenching truth to the family and witness the tears and howls, yet offer words of comfort to someone who can now finally be at peace with what is to come, and to his loved ones who are prepared for it... and that can make all the difference in the world.
The situation can perhaps only be best expressed by the author himself:
“Is it finally time for doctors to be trained to prepare people to die rather than simply be kept alive as long as possible?”
This is a book about mortality, about the conceptions that man has contrived over the years to explain it and if possible, evade it indefinitely. The text is filled with interesting anecdotes, incidents, and stories which acquaint the reader to the author's unique voice, one of concern and love for his profession while striving to pinpoint its modern-day flaws. Juxtaposing beautifully the noble intent of medicine to release a person from the bonds of suffering to happy health, with the moralistic dilemma of doctors accepting the supremacy of death and disease when the time arises, this is a must-read for all those looking for a thought-provoking foray into how patient care can, and must, evolve revolutionarily in the years to come.