The eventuality of death and market influences forces everyone to confront the subject of their mortality sooner or later, however briefly and despite any reluctance we feel about the subject. Five minutes ago, I watched a commercial for AARP. I did not want to, and the entire fifteen seconds it played I fidgeted in my chair until finally, finally, I could get on with the business of watching sports and living my life on my terms.
It would not surprise me if most of the time people put off thinking about and discussing aging and death because psychologically those discussions produce anxiety or culturally we perceive them as morbid. Perhaps, superstitiously, some of us might even avoid these subjects because talking about death makes it seem like more of a reality or even invites or accelerates its onset. Gawande’s powerfully reflective and well-researched book invites valuable contemplation and conversation about a topic most of us would rather keep at arm’s length.
Ignorance might be blissful for a while, but as Gawande argues it does not improve the quality of life of those confronting an end-of-life scenario. Planning ahead and thinking about goals can help people live their fullest life. In the practices and philosophies of modern medicine, the extension and preservation of life for as long as possible is often seen as a good in and of itself. Gawande points out, however, that emphasis on that goal can lead to excruciating experiences for terminal patients and may do more harm than good in the end because obsession with living longer may make life less bearable. Other avenues, such as hospice, palliative care, and assisted living facilities, exist for aging and terminally ill patients to help them deal with pain and other challenges or receive the support that they require to maintain or approximate the kind of life they wish to experience in the time they still possess.
One of the most powerful components of Gawande’s book is his description of his own father’s experiences with cancer. It is one thing to have conversations about end-of-life goals with patients; it is quite another to have those conversations with a loved one and honor their decisions. Gawande writes,
“At least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortality—the courage to seek out the truth of what is to be feared and what is to be hoped. Such courage is difficult enough. We have many reasons to shrink from it. But even more daunting is the second kind of courage—the courage to act on the truth we find….One has to decide whether one’s fears or one’s hopes are what should matter most.” (232)
These are the kinds of reflections Gawande’s book provokes. Talking about such serious topics is not just the opportunity to consider the eventuality of our mortality, but also the assignment of responsibility and the invitation to act on the needs and desires of others.
As a teacher, I can see Gawande’s book being assigned as a fundamental text for either a life-span or human development course, classes I took as a sophomore psychology major. In many of the twentieth century theories on human development, the elderly are marginalized and forgotten, a theme that permeates entire cultures. It would also work well in a literature and medicine course, pairing well with Anne Fadiman’s The Spirit Catches You and You Fall Down (1997), which also uses an ethnographic/journalistic approach to write about the tensions between modern medicine and traditional cultures. I would also recommend Joan Didion’s The Year of Magical Thinking (2005) as a good companion text to Gawande’s book because I see Didion’s account as an insider’s perspective on the subjects of mortality, loss, and grief.
Gawande’s book may be an uncomfortable read for some audiences because of the subject matter and the stories he shares about aging and terminally ill patients, but it is a must-read for its gentle honesty and hopeful tone as he touches on the individual aspects of what and who matters most or should matter most in a person’s life.
Reviewed by Jeff Howard