What does it mean to be mortal? Are we deluding ourselves into believing we will live forever? Are we making bad decisions based on the assumption that we can live longer than we will? Physical and author Atul Gawande investigates all this in his book Being Mortal: Medicine and What Matters in the End. I’d highly recommend it.
Being Mortal Description
Medicine has triumphed in modern times, transforming the dangers of childbirth, injury, and disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should.
Through eye-opening research and gripping stories of his own patients and family, Gawande reveals the suffering this dynamic has produced. Nursing homes, devoted above all to safety, battle with residents over the food they are allowed to eat and the choices they are allowed to make. Doctors, uncomfortable discussing patients’ anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them. And families go along with all of it.
In his bestselling books, Atul Gawande, a practicing surgeon, has fearlessly revealed the struggles of his profession. Now he examines its ultimate limitations and failures – in his own practices as well as others’ – as life draws to a close. And he discovers how we can do better. He follows a hospice nurse on her rounds, a geriatrician in his clinic, and reformers turning nursing homes upside down. He finds people who show us how to have the hard conversations and how to ensure we never sacrifice what people really care about.
Riveting, honest, and humane, Being Mortal shows that the ultimate goal is not a good death but a good life – all the way to the very end.
Key Takeaways from Being Mortal
Everyone will get something different from this book, but here are my key takeaways.
Turning Life Problems into Medical Problems
Humans go through problems as we age. As a society, we turned many of those problems into medical problems and leaned on the medical community to “fix it.” But while many of our problems have medical symptoms, they aren’t medical problems. Better relationships, habits, social networks, and purpose can solve many ailments.
There are certainly medical problems that grow more acute as we age. But expecting body doctors to fix our mental and relational problems is like expecting teachers to solve the poor grades of students with a bad home life. We’ve put too much responsibility on the professionals to deal with our personal and family problems.
The Medical End-of-Life Pipeline
There is an End-of-Life pipeline we expect older people to go through. It starts in the home and ends in the home, with a few facilities along the way.
- Independent living facility
- Assisted living facility
- Nursing home
- Funeral home
But not everyone needs this. Too many are forced into this pipeline because of a lack of awareness of alternatives, proper planning, and tough conversations.
The Role of the Doctor
There are three styles of Doctors’ Advice:
- Paternal: The Doctor tells you what to do because they know best.
- Informative: The Doctor informs you of your choices and lets you decide.
- Interpretive: The Doctor asks you about your goals, fears, and wishes, explains your options, and provides guidance on which will help you achieve your goals.
Most doctors seem to opt for number two. They get to be the expert, but all of the weight of the decisions fall on the patient. Atul advocates for number three. So do I. It reminds me of the best in my profession.
Beyond these takeaways, there is a theme he explores, which we will call:
Living Well and Dying Well
Abraham Lincoln once said, “In the end, it’s not the years in your life that count. It’s the life in your years.”
Far too often, we sacrifice the quality of our life for the quantity of life. We give up the life in our years for more years of our life.
There was an avid runner who ran three hours a day and planned to for the rest of his life. Someone asked him, “Why do you run so much?”
The runner replied, “If I run 3 hours daily, it will help me live five years longer!”
The other did some quick math. “What’s the point of living five years longer if you have to spend a combined eight years running to get there?”
Most money spent on health care is spent in the final few years of life, often trying to prolong it. More and more time is spent in hospitals to extend life. Sometimes, we undergo horrible treatments or surgeries to eke out a few more painful months, maybe a year.
Perhaps we should ask what was asked of the runner. “What’s the point of living an extra year if we needed to spend a combined three years in treatment to get it?”
Perhaps we should focus more on our quality of life than our quantity.
Four Questions for Tough Medical Decisions from Being Mortal
Atul contends that a lot of this is brought on by doctors giving false hopes. A patient’s situation is dire. The doctor informs the patient and family that treatment X may extend their life but may have a litany of side effects. What isn’t necessarily disclosed is that while the patient and family hope for years of life, the doctor hopes for weeks or months.
If we were more honest about our situations and more deliberate about our conversations, we could live and die better. Atul suggests four questions that patients should be asked when faced with tough medical decisions.
- What is your understanding of where you are with your health?
- What are your worries for the future?
- What are your hopes and priorities?
- What are you willing to sacrifice, and what are you NOT willing to sacrifice?
By thinking through these questions and discussing them with your doctor, you may get interpretive-style guidance instead of just information. While it may not make the final decision easier, most find it made it better, and they had more peace afterward.
Estate Planning is Everything
Being Mortal emphasized the power of estate planning. Generally, we think of wills and trusts, but an often overlooked element is Advance Directives and Health Care Power of Attorneys.
An Advance Directive also called a “Living Will” or “Health Directive,” is your wishes for your healthcare when you can no longer make these decisions alone. Thinking and talking through the decisions in a directive is critical for ensuring the right decisions are made.
Atul highlights La Crosse, WI, where I’m from, as a community doing this right. Gundersen Health Systems has been strongly encouraging people to get these done, and as such, we have some of the lowest end-of-life care costs in the nation.
Health Care Power of Attorney
You can’t possibly think of every health scenario, so nominating a POA to make the additional decisions for you is critical. And so is having conversations with them. While it may be complicated or uncomfortable, sharing your wishes with your POA significantly improves later situations. Use the four questions from above to guide the discussion.
You may be thinking, “I thought this was a finance podcast. Why are we talking so much about health?”
It’s a “retirement” podcast, and health is a big part of retirement. But it’s more than that.
Most of us hear the same message from financial professionals our whole lives: “Save, save, save.” It’s hard to unwind those messages when they root down deep. If nothing else, take all this as permission from a Certified Financial Planner to spend your money.
You can spend it on life experiences. You can spend it on getting an estate plan. You can spend it all down enjoying life and then opt for six months of hospice instead of two years of treatment. It’s your money, your health, and your life. I’m just here to help you optimize it. And the book, Being Mortal can also help you think through these things.
Being Mortal and Being Eternal
We are mortal. This body doesn’t live forever. We will all face death someday, and we have the opportunity to live and die well.
We are also eternal. While our body passes away, our souls live forever.
A quick word to my fellow brothers and sisters in Christ: Shouldn’t the certainty of where we’re going when our body dies change how we live out our final days? Surely, our confidence in Christ should cause us to opt for living better and dying sooner to be with him than to try and prolong a dying body. All Christians should think deeply about this as they approach their life expectancy.
And a quick word to anyone still listening who isn’t absolutely sure what happens when they die. Shouldn’t you be sure? Being mortal and being eternal are not mutually exclusive. If you’re not positive about your eternal destination, I’d love to talk about that more than your money. Call me, 855-6MENTOR. While I would never recommend a whole life policy, I do recommend you get an eternal life policy. I know the only one with guarantees.