Being Mortal by Atul Gawande

This is an important book. It has important implications for most of us, is a deeply felt book about that most difficult topic, the final days of our "being mortal."

Atul Gawande, our author, is eminently qualified to write it. The son of immigrants from India, both of whom are or were physicians, Gawande is a graduate of Harvard Medical School where he now teaches, while also being a best selling author and a staff writer for The New Yorker.

Gawande explores our society's attempts and those of the medical profession to "build a health care system that will actually help people achieve what's most important to them at the end of their lives." Early in the book, he relates the final days of his grandfather who died in India at the age of 110, surrounded, supported, and cared for by his family. In the latter part of the book, he tells how he and his father struggled to achieve something similar here in America for his father-and how difficult it was, despite both of them being physicians. Gawande tells both stories with heartfelt involvement and compassion.

He also traces in some detail how our society has developed several institutions to help people in their final months: the county poor home, the nursing home, assisted living homes, hospice. Gawande points out how each of those institutions has fallen short of providing the kind of care that we would all want for ourselves and for those we love. At one point, he draws attention powerfully to how some nursing homes and prisons are seen to resemble each other.

Throughout the book, Gawande enriches his telling with the experiences, in their final days, of patients of his and of people who were important to him. He focuses again and again on the importance of the conversations between the patient, the physician, and the patient's family and says, importantly, "No one conversation can address" all the concerns of those days, and adds, equally importantly, that "the process requires as much listening as talking."

Toward the end of the book, Gawande writes briefly about the Village Movement, which began with the Beacon Hill Village in Boston. A local Village organizes all the kinds of help a person wishing to continue living in his or her own home would need from a handyman to in-home nursing care. He mentions it because a Village had recently been organized in Athens, Ohio, where his parents lived, and thus was an option for his father. When the Gawandes were faced with the choice between the Athens Village and hospice, they chose hospice. (Good news: efforts are now afoot to organize a Bellingham village called Bellingham At Home.)

Reading Being Mortal has given me a new perspective on my own final health directives, and I'11 find out more about Bellingham At Home. I think almost everyone would benefit from reading Being Mortal and pondering its implications