When I first read Being Mortal, in 2014, I encouraged everybody within earshot to get a copy. That included our kids—I told them it offered a perspective that could be helpful now that their parents were being defined as seniors. Our son, an avid reader, noted that he and his sister didn’t need a book to guide them to do the right thing. I agreed but argued that the book could make it much easier to recognize what might be right and what less so, at a time when choices are muddy and time short.

Eventually he read the book because Roger got cancer. At first, I was a little annoyed by this. Josh didn’t see the need for the book in assessing our mortality, but it helped him process the imminent death of his pet. Roger was a cat. But I soon saw this for what it was. He was taking his role seriously. Roger could not speak for himself, and as Roger’s caretaker, Josh wanted to spare him unnecessary pain, but he didn’t want to say goodbye sooner than necessary. He figured out the process with Roger and, should he face it with us, he’s prepared. But it helped him give a much-loved pet what he needed, and what more could I ask? Well, I could ask that he do the same for me, and it goes without saying that he and his sister will.

But this book could help provide answers to problems they don’t anticipate.

Clearly, I haven’t stopped talking about it. It shot to the top of my list as one of the most important books I’ve ever read. After ten years, I read it again to see if it held up. It did. I was as entranced the second time as the first. Even more so because, as it happens, I am also now ten years older.

In the meantime, I have helped a good friend move into assisted living, then into memory care. I have watched my circle of friends, young and old, make end-of-life decisions. And I have seen the proliferation of senior communities in my city, many looking like four-star hotels, with four-star pricing. Many truly provide exceptional care for a growing population of aging boomers with healthy 401Ks. But what about everybody else? And are these an ideal solution, no matter your budget?

Atul Gawande helps us sort that out.

Gawande is a gifted storyteller, having won two National Magazine Awards for his work on The New Yorker; he has been awarded a MacArthur Fellowship. In his spare time, he is a professor at the Harvard Medical School and the Harvard School of Public Health.

Like most doctors, Gawande was focused on helping his patients overcome their diseases and disabilities. He knew some wouldn’t survive, but he wasn’t trained to cope with the truth of mortality. To a doctor, a patient’s death can mean failure.

The book chronicles how all that changed for Gawande.

He asks, “What does it mean to be good at taking care of people whose problems we cannot fix?” And then he makes it his mission to find out.

Gawande gets to know the people he treats—their backgrounds, personalities, aspirations—and he takes time as a writer to make them real to the reader. Many of them are coming to understand that medical science has no cure for them—although, he explains, most still hope a miracle might be out there somewhere. As does he.

He delves into where and how we expect people to live when they become frail. We often institutionalize people in facilities too often designed to fulfill the needs of the medical staff, not the patients, he says. Our focus on safety can come at the detriment of wellbeing.  

He shows us better options, such as the nursing home in New York state that provides animals for patients to care for and has a children’s playground on site for a jolt of energy.  And others throughout the country designed to look and work like homes, not hospitals. Hospice has become a life-affirming option for those with terminal illnesses.

But he also shows us that many well-intentioned plans have gone off the rails because of institutional rules and economic gain. The concept of assisted living, for example, was devised as a way for residents to retain a sense of independence and privacy. The first such facility had doors that locked and allowed residents to drink wine, gorge on M&Ms, and sleep as late as they wanted. Eventually, though, safety concerns overcame the goal of patient independence, and soon the doors were unlocked, the M&Ms and wine were discouraged, and residents were expected to wake up at the convenience of the staff.

When I visited my friend Mary in memory care recently, the nurse’s aide said she’d wake her in the morning at 6:30 for breakfast. “That’s too early,” Mary answered. “I like to sleep late.” They agreed on 7. Geez.

If we want to ensure that our loved ones—and, eventually, us—end our lives on our own terms, Gawande says, we need to start listening. What gives our specific lives meaning? In one instance, a man is facing a serious operation during which the doctors will have to decide if they continue with extreme life-saving procedures or if they stop. Before the surgery, the man is asked to name what would make his life worth living. He responds that he wants to be able to watch football and eat chocolate ice cream. That, then, becomes the doctors’ criteria. If the patient can have those two things, his life has meaning. If treatment takes that away, treatment needs to stop.

Sometimes hospice care is the most life affirming, he says, citing the Coping with Cancer study, which followed patients who chose to enroll in hospice rather than have advanced treatment. “They suffered less, were physically more capable, and were better able, for a longer period, to interact with others,” he writes.

As the book progresses, Gawande’s beloved father, also a doctor, is diagnosed with cancer that defies treatment. He ultimately chooses to let his cancer progress naturally, allowing him to continue interacting with others, including hosting dinners for friends and colleagues. He knows he’s dying, but he’s not dead yet.

This book truly changed my perspective on living and on dying. Should I have a life-ending illness, I want to continue to visit meaningfully with Joe, our kids, and grandkids. If treatment takes that away from me, I don’t want it.  Joe and I both have living wills, making our end-of-life wishes clear.

This is not a how-to book. Gawande shows us the problem and how some patients and families cope, but he leaves our decisions up to us.

NOTE: You can watch Gawande’s story of the PBS Frontline episode titled, Being Mortal, where you’ll meet him and some of the people he introduces in the book, including his father.

Portions published in Psychology Today, April 6, 2024