Thoughts On Atul Gawande's 'Being Mortal: Medicine and What Matters in the End'

I've recently been given the task of reading a book that is about aging, and the manner in which we medically and societally deal with deteriorating due to old age. It will take me a while to read this book, so as a way to digest the information I'm reading and share my thoughts I'm going to be blogging about this book for the next couple of weeks.

To open, Atul Gawande-the author, tells an anecdote about his great-grandfather. Gawande lays out some of the traditions and familial practices in order to display differences between his grandfather's reality in rural India, and the reality that Gawande himself has lived in and grown accustomed to. One passage that caught my attention was Gawande's mentioning of the fact that living to old age has been an uncommon occurrence throughout much of human history. Old age was once accompanied by reverence and coomunity respect. The elderly were looked to as the guardians of tradition, knowledge, and wisdom. Patriarchs and matriarchs of families were consulted about decisions that affected the family and/or community, and were cared for by their families.

May I note that I am not leaning one way or another in terms of the way that old age is viewed. I have my ideals concerning old age, but for now I am simply offering topics for thought, and menioning concepts that my readers can reflect upon. Gawande also mentions that old age and the health concerns that accompany old age have become a responsibility of a small number of individuals and their care providers. Even today, many cultures around the world enlist the help of multigenerational care within their families in order to care for their elderly relatives. In fact, the elderly, especially those with declining health, often live with a number of their family members. Though this custom has been trending in a downard direction across the globe. The percentage of elderly that live with relatives is decreasing worldwide.

In the U.S., the popular idea is to either move your elderly relative to a nursing home, a retirement community, or have them live alone. They may not be alone if their significant other is alive, but the fact remains tht it is not common practice for U.S. citizens to be the first line of care for their elderly realtives that have declining health.

What I've enjoyed about this book so far is the mix of medical wisdom and social relevance that Gawanade has combined into this piece of literature. For example, Gawande touches upon the friction that has arisen due to increased life expectancy. Parents and grandparents now clash with their children over property, finances, and decision making. Children anticipating independence and autonomy may find themselves bending to the demands their parents, and visa versa. Gawande goes on to point out that in terms of healthcare, modernization has not demoted the elderly. Though it may seem as if the elderly recieve less care and attention, modernization has demoted the family. Individuals are free to choose whether they wish to live among their family or move away. The elderly can move to a specialized community if they choose, and the young can start a life of their own away from their family because their elderly residents no longer exclusively depend on their younger family members for care.

As I've noted, medicine has changed life in many ways. Life and health trajectory have shifted within the last 60 or 70 years in the United states. Chronic illness in the ederly often lead to cyclical periods of sharp declines in health followed by steady improvements. Inevitably the trend continues downward as the individual becomes less able to recover from previous declines in health. The medical strategy becomes focusing on ways to maintain an individual's remaining health.

For others, the descent toward death is gradual, and a full and lengthy life is enjoyed. The best way to describe it would be to ask you to envision a slight decline down a hill. Not strenuous or unnerving, but just enough to notice. I want anyone reading to reflect upon the the way that the society that you live in views the elderly and how you think that effects their access to health and your views of health care. I also want you to think about how your customs and thoughts toward elderly individuals may differ from those of other cultures around the world.